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Beds filling at 'exponential rate' in Banner hospitals, surgeries halted

Banner warns of 'rolling diversions' & 'pause' on elective procedures as hospitals operate above capacity

Hospitals operated by Banner Health across Arizona, including those in Tucson, will halt elective surgeries as the number of COVID-19 patients taxes the ability of doctors and nurses to care for everyone.

The chief medical officer for Banner, which operates 23 hospitals in the state, warned that COVID hospitalizations continue to increase "at an exponential rate" and that the number of beds occupied by coronavirus patients has nearly tripled since November 1. 

To deal with the influx, Banner may use "rolling diversions" — closing hospitals temporarily to incoming emergency patients — and move patients to other cities or states to deal with a "dynamic" situation. Banner will pause elective surgeries beginning Friday. 

Half of all patients admitted in Banner hospitals are COVID-19 patients as the state reached "several grim milestones" this week in the fight against the novel coronavirus, Dr. Marjorie Bessel, Banner's chief clinical officer, said during a press conference Wednesday.

"In December, bed occupancy increased by 150 percent," Bessel said. On Dec. 29, Banner's Arizona hospitals reached 104 percent of their licensed capacity, and some hospitals have been operating "well above that threshold for some time now."  

She noted that Banner Estrella, a hospital in west Phoenix, was operating at 125 percent of its licensed bed capacity. 

Banner has two hospitals in Tucson, including University Medical Center on North Campbell Avenue, and Banner University Medical Center South on East Ajo Way. Banner also manages a third facility north of the University of Arizona campus, as well as several clinics and other facilities in Tucson.

Tucson Medical Center — which had stopped elective surgeries on December 20 — has begun scheduling a limited number of procedures beginning next week, sources at that hospital said.

600% increase in COVID ICU patients

Overall, the number of ICU beds occupied by COVID-19 patients has increased six-fold since November 1, Bessel said. Some hospitals have worked to increase their ICU capacity by nearly 250 percent. Despite this expansion, ICU occupancy is far and above what's considered peak winter volume, and Banner's hospitals were at 170 percent of their usual volume for patients. Of those, more than half, or 58 percent, are COVID-19 patients, she said. 

In recent months, Banner has hired an additional 2,294 people to work at the hospital, and was recruiting another 176 more, but staffing remains the "limiting factor" in Banner's ability to expand capacity, Bessel said. Banner was also working to "redeploy" staff and transfer supplies from hospitals in Colorado and Wyoming, she said. 

"As I have said in the past, these COVID-19 patients are very very sick," Bessel said. "They require a great deal of care and much longer stays in the ICU compared to the typical ICU patient. Many of them also require the support of a ventilator." Bessel added that since November 1, the number of COVID-19 patients relying on a ventilator had increased seven-fold since the beginning of November. 

The novel coronavirus has infected more than 19 million people in the U.S., and killed 329,605 people, according to the COVID-19 Tracking Project. Nationwide, nearly 125,000 people are currently hospitalized, and nearly 23,000 people are in intensive-care units nationwide. In Arizona, more than 512,000 people have been sickened by the virus since March, and 8,718 people have died, said state health officials. On Wednesday, 78 people were reported dead, and the state added 5,267 cases. 

The rate of fatalities in Arizona due to COVID-19 is more than 1 person for every 1,000, state data shows. 

All of these increases led Phoenix-area hospitals to begin going on diversion—blocking incoming emergency transports and hospital transfers. On Tuesday, six Phoenix-area hospitals went on diversion. The day before, 10 hospitals in the area were on diversion. 

"This means that the hospitals are closed to incoming emergency transports and hospital transfers while they quickly work to address a backlog of patients. Diversion does not apply to walk-in patients who need emergency care," Bessel said.

"It is not uncommon for hospitals to go on diversion during the winter when volume is higher, but it is unusual for so many to be on diversion at the same time—with the length of stay and complexity of care for COVID-19 patients adding to the challenge that this presents," she said. Phoenix-area hospitals will move toward "rolling diversions" during which certain hospitals will close for specific times so they can manage their backlog, while other hospitals remain open. "This process will help to balance the load so that no one hospital or health system becomes overwhelmed with patients," Bessel said. 

"When multiple hospitals in the same area need to go on diversion at the same time, it is very concerning. For those seeking care, you may be transported to a hospital that is further away from your home and you will experience longer wait times," she said. 

To deal with the influx of patients, Banner Health may move patients to different cities, and even different states to manage what she called a "dynamic" situation. "We do intend to continue to move patients to load balance the best way possible so that we can provide the most care to the most patients in the best possible way," Bessel said. She also warned that Banner may begin using triage to manage the number of patients. 

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"As I have said before, Banner and the other hospitals and health systems in the state are doing everything we can to prevent a triage situation, but we cannot do it alone. We need more mitigation, more enforcement and more personal commitment from Arizonans to reduce the spread of COVID-19," she said. 

While she praised the importance of vaccines, saying that Banner was pouring efforts and hours into vaccinations, she warned that Banner may be forced to triage care because of the influx in patients. 

The state has around 200,000 doses of the COVID-19 vaccine, and statewide about 40,000 people, largely doctors and nurses working with COVID-19 patients. However, on Wednesday, Ariz. Gov. Doug Ducey announced the state was going to bypass county vaccination plans and set up a system run by the Arizona Department of Health Services. 

Banner is not currently doing triage or rationing of care, Bessel said, but the hospital system is "operating outside of our usual and customary processes under the crisis standards of care that was allowed under Arizona," she said. 

"It is our absolute intention to do everything possible to avoid getting to a triage or rationing situation, but we need your help. We must mitigate further, and we need you to make different decisions this upcoming holiday weekend. Shrink your circle and wear your mask," she said. 

In Pima County, county officials have instituted a mandatory curfew from 10 p.m. to 5 a.m., pushed for people to remain home, and asked people to maintain a six-foot distance to minimize the spread of COVID-19, along with a requirement for people to wear masks. 

"I am a physician, and as that, I'm also a scientist. And I am very frustrated during this pandemic, because I feel that we can do better," said  It is very difficult disease to care for these patients that need us. There are individuals who are dying from this disease, as I shared earlier in my comments-- over 339,000 Americans. These individuals that are in our hospitals are very ill. And even individuals that don't need hospitalization can be very ill at home, and we know that many of them are suffering long-term consequences.

"Mitigation will help us reduce the burden of disease," Bessel said. "It will help less people become ill, it will help less people be hospitalized, it will help less people be in the ICU, and it will ultimately help less people to die. Mitigation will help us." 

"Shrink your circle. Make different plans for New Year's," she said. Do not host or go to a gathering, and wear your mask fully above your nose and your mouth.

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Paul Ingram/TucsonSentinel.com

Doctors and nurses at Banner University Medical Center's North Campus begin vaccinations on Dec. 17.