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UIHC 'Struggling' To Meet Patient Needs Due To Lack Of Capacity

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Penn State via flickr creative commons
Iowa's largest hospital is struggling to meet patients' needs due to a lack of capacity, and an increase in the acuity of patients' illnesses.

Iowa’s premier hospital is struggling to keep up with the flow of patients from across the state due to a lack of available beds, according to a top administrator. Some six months into Iowa’s coronavirus pandemic, even non-covid patients at the University of Iowa Hospitals and Clinics are arriving sicker than usual and staying longer, leading to a backlog.

In the early days of the coronavirus pandemic, the UIHC saw a drop off in demand due to the cancellation of elective procedures. The ban has since been lifted, and with it, patient volumes have shot back up.

But compared to before the pandemic, patients coming to the UIHC are in worse shape, requiring more care and longer hospitalizations.

UIHC Chief Executive Officer Suresh Gunasekaran told the Iowa Board of Regents on Wednesday that hospital staffers are “struggling."

“Overall what this means is that we are seeing a higher volume of sick patients from around Iowa that need to come to UIHC and we are struggling to keep up,” he said.

Gunasekaran says the increase in acuity of sickness is not limited to COVID-19 patients; he reasoned that non-COVID patients are likely becoming sicker as well after foregoing needed care for chronic illnesses in the earlier days of lockdown. The hospital has also seen an increase in behavorial health needs.

The UIHC is the state’s leading research hospital, and its largest, with 811 beds, and often takes on the most challenging cases from not just across eastern Iowa but around the state whose needs may exceed the capabilities of smaller hospitals.

But that “referral center” role is being made more difficult due to the current strains on capacity.

“The transfers and the volumes that we’re seeing are a challenge. So inpatient transfer volumes have pretty much returned to the same numbers of patients trying to transfer from around Iowa into UIHC as pre-COVID. Unfortunately those patients are a lot sicker now” he said.

The hospital is continuing to accept all COVID-19 transfers. But Gunasekaran says the lack of beds at the UIHC is adding pressure on some of Iowa’s other hospitals, many of which are likewise struggling to stay solvent during a global pandemic that has brought both increased costs and decreased revenues.

“We’re only accepting the transfers that we can, which largely means many state hospitals, many hospitals across the state are disappointed when we decline to make a transfer. And many have complained to me because they believe it’s happening at a higher rate than it did before,” he said. “That’s not the case. We have sicker patients than we did before.”

The “crunch” is also leading to delays in care at the UIHC’s own emergency department. Gunasekaran says in August, 20 percent of patients left the ED without being seen, a rate that he says has “never happened” and speaks to “being overrun by patients from out of town."

Gunasekaran says the hospital is working on ways to expand bed capacity, both for COVID and non-COVID patients, and is hiring more permanent and temporary staff to meet demand.

“My number one priority is to make sure that our staff stay strong throughout this entire ordeal. It is a marathon,” he said. “I hope we’ve reached the halfway point.”

Despite the challenges, the hospital is on more solid financial footing than it was earlier in the pandemic, in large part due to an infusion of federal coronavirus relief funding.

The UIHC has received $31.1 million from the CARES Act through fiscal year 2020, which along with restarting elective surgeries, has helped keep revenues higher than expenses.

The hospital came out nearly $14 million over budget at the end of fiscal year 2020. Chief Financial Officer Brad Haws says that’s not as large of a margin as the previous year, but he says that’s a marked improvement from earlier in the pandemic when the UIHC was losing some $2.5 million a day.

“With the impact of some stimulus funding, we actually ended up pretty well,” Haws said. “We actually ended ahead of our budget, which I think is remarkable.”