Hospital still under pressure

The situation changes day by day at Crook County Memorial Hospital. While the number of recorded active cases in Wyoming has been trending downwards, the number of people hospitalized with COVID-19 hit an all-time high last week and, like many of Wyoming’s healthcare facilities, Crook County Medical Services District (CCMSD) is still feeling the strain.

“Every time we have a couple of calm days and think that maybe there will be some reprieve, we have a day with multiple positives,” says CEO Micki Lyons.

“Things seem to be calming down some, but it also seems to be a day-to-day situation.”

This is a reality reflected in the numbers, which are recorded on an ongoing basis by the Wyoming Department of Health and show that Crook County’s patient count has been in considerable flux over the past couple of weeks.

At one point, on October 4, the hospital was caring for five COVID-19 patients – more inpatients than at any other time during the pandemic. The daily number of patients temporarily dropped off after this, although they continued to periodically spike, before climbing again to four by the end of last week and remaining there through the weekend.

Because there aren’t enough rooms within Crook County Memorial Hospital to cope with this number of patients, the staff has made some innovative changes to the facility. Most recently, says Lyons, “We have turned our waiting room into a space for additional beds.”

She notes that, at this time, those new beds are not in use.

For a small hospital like the one in Sundance, the number of local cases compared to the number of available beds is only the beginning of the problem. CCMSD has long relied on larger medical facilities in the surrounding area for deeper levels of care than can be provided within a rural hospital, but many of these have found themselves similarly overwhelmed.

“It remains difficult to find beds in surrounding hospitals for COVID-19 patients particularly,” Lyons confirms. “Surrounding areas are getting hit hard with COVID-19 as well and staffing is a huge problem across the country.”

The Casper Star-Tribune reported last week that five Wyoming hospitals have at some point gone into crisis standards of care during the most recent surge of infections because they did not have enough resources to care for all patients.

Crisis standards are utilized when healthcare resources are limited during a public health emergency such as during a pandemic; they provide guidance for healthcare providers on how to ethically allocate those resources through a triage process.

Hospitals to which CCMSD would generally send transfer patients may or may not be on that list, but Crook County Memorial Hospital itself has so far avoided reaching that point.

“We are not fully staffed and it is a struggle especially when we need to call in extra help for additional admits or when staff call in sick,” Lyons says.

“Our staff has been working hard and these have been very trying times. Many are willing to pick up additional hours but they are exhausted and burnout for staff is a real concern.”

At this time, due to the overall situation, Lyons says visitation is still closed in the main hospital and long-term care facility. The rate of positive cases is being watched carefully, she says.

Last week, that rate was at 13% of all tests coming back with a positive result.

“We will continue to evaluate and, if we can get below the 10% threshold, we will consider opening visitation up again,” Lyons says.

The number of hospitalizations in Wyoming hit 249 on Thursday, breaking the previous record number of 247 hospitalizations at the end of last November. However, known active cases are much lower than at that time: 3457 on Thursday, compared to 8612 on November 30, 2020.

The reason for this disparity is unknown. However, according to the Casper Star-Tribune, health department spokesperson Kim Deti suggested it could be attributed to the more serious illness associated with the Delta variant, people avoiding testing or a combination of both.