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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Rural Hospitals Struggle To Find Beds Amid Uptick In COVID-19 Cases

Courtesy of Erik Martin
Erik Martin is an emergency physician who works in southern Missouri and Oklahoma.

This is part one of a two-part report on how rural hospitals across Missouri are dealing with the surge in COVID-19 admissions. 

30 hours — that’s how long it took Erik Martin to find one of his patients a hospital bed.

Martin is an emergency physician who works in hospitals throughout southern Missouri. “It was pretty frustrating, because we had to call a lot of different hospitals and they just couldn’t help us," Martin said.

He called hospitals across the region as well as across the border in Kansas and Oklahoma. “He was there overnight and it seemed the next day he wasn’t going to be able to be admitted," Martin said. 

Eventually, he found a bed for the man some 200 miles away from home. That’s become increasingly common, as hospitalizations in the state have shot up from 1,600 at the start of November to more than 2,600 as of December 5, according to the Missouri Department of Health and Senior Services.

Martin helped out in New York City during the surge in cases there in the spring. He says the health system was overwhelmed by the number of patients, and he fears the Midwest is heading in a similar direction.

“If the number of hospitalizations continue to climb we worry that that will impact patient care not only for COVID patients but for non-COVID patients,” Martin explained.

Credit Courtesy of CoxHealth
Cox Health in Springfield has drastically increased its capacity since the start of the pandemic.

With hospitalizations up across the region, larger health systems — that would normally accept patients from smaller, rural hospitals — have had to turn people away. Cox Health in Springfield is one of the biggest health providers in southern Missouri.

CEO Steve Edwards says the hospital has been on diversionary status — meaning it can’t accept transfers — for as much of two thirds of the day.

“Maybe at the end of the day, we’re big enough that we might have 40 discharges, and so that can create capacity for that evening or that next day," Edwards said. "But with a forecast of another growth spurt — we are really challenged.”

Cox has expanded its capacity by nearly 150 beds since the start of the pandemic. But meeting the growing need requires more than just physical space. Treating COVID-19 patients requires training, and pulling staff to treat them is difficult.

“Big hospitals become highly specialized in their expertise, not only just the physical design but also the staff, so it’s hard to flex,” Edwards explained. 

One hospital that has referred patients to Cox is Citizens Memorial, 50 miles north in Bolivar. Tim Wolters, director of reimbursement at the hospital, points to the speed with which transmission, and admissions have increased. 

"I think there were a total of four deaths in Polk county for the first six months, and there have been a total of 18 deaths in the past two months,” Wolters said. 

The 86-bed facility is dealing with the same problems as other providers in the region, which is straining under the surge in cases.

“They obviously have more capacity at Mercy and Cox down in Springfield, but it’s still at times difficult to transfer patients who need more specialized care there,” Wolters added. 

Researchers have found longer stays in emergency rooms are linked to worse health outcomes and more deaths in the long run.

Credit Courtesy of Citizens Memorial Healthcare
Citizens Memorial Healthcare
Citizens Memorial Hospital is an 86-bed facility in Bolivar, in southwest Missouri.

Wolters says the staff at Citizens Memorial are working to meet the growing demand, but if trends keep up, the hospital could be forced to delay scheduled or elective procedures. Citizens memorial recently announced it was working on a special unit for COVID-19 patients who are recovering from the disease, but no longer need acute care.

The hospital is also preparing for the arrival of a vaccine, something providers have described as a glimmer of hope amid the pandemic. But vaccine distribution and application for healthcare workers could still take weeks, and in the meantime, providers like Martin are wary of another surge in cases from the holiday season.

For his part, Martin says he’s seen some positive changes recently. In particular, smaller hospitals increasingly treating patients on site rather than referring them elsewhere.

“I think we can't expand that indefinitely," Martin cautioned. "Smaller hospitals aren't used to to keeping a lot of patients and they have a limit as well: a bed capacity limit.”

Look for part two of this report on the Health & Wealth Desk December 16.

Sebastián Martínez Valdivia was a health reporter at KBIA and is documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.
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