Hospitals nearing capacity ordered to limit non-urgent procedures

Sudders cites staffing shortages, longer stays, COVID surge

MASSACHUSETTS HOSPITALS that are running out of bed capacity will be required by the state to reduce the number of non-essential, non-urgent procedures they perform under an order issued Tuesday by acting Public Health Commissioner Margret Cooke. 

The order comes as the state is seeing another surge of COVID cases and as hospitals have been taxed due to staffing shortages and sicker patients who delayed care early in the pandemic. 

The current strain on hospital capacity is due to longer than average hospital stays and significant workforce shortages, separate and apart from the challenges brought on by COVID,” said Secretary of Health and Human Services Marylou Sudders in a statement.“COVID hospitalizations in Massachusetts remain lower than almost every other state in the nation, but the challenges the healthcare system faces remain, and this order will ensure hospitals can serve all residents, including those who require treatment for COVID-19.” 

The order, which goes into effect November 29, is more targeted than the blanket ban on elective procedures that the governor put in place at the beginning of the COVID pandemic. Under the latest order, the Department of Public Health will set a capacity threshold for individual hospitals and health care systems for both medical-surgical and intensive care beds. The threshold will be set at roughly 85 percent of the beds available.  If a hospital exceeds that threshold, the restrictions will go into effect and the hospital will have to reduce the number of non-essential, non-urgent procedures it performs by 30 percent compared to its average pre-COVID volume. A hospital will remain exempt from the restrictions as long as it maintains its capacity without having to transfer patients elsewhere. 

Non-urgent procedures are defined as those that are scheduled in advance and can be delayed without  adversely affecting the patient’s health. 

Baker officials said in a press release that the capacity limit  is necessary to ensure hospitals have enough inpatient capacity to meet the need for immediate, urgent health care. Hospitals are now operating at around 90 percent capacity statewide, and hospitalization rates generally increase by 10 percent between late November and January. 

While Massachusetts is experiencing another surge of COVID patients, hospitals are not being strained by COVID itself, likely because vaccines have proven effective against serious illness. Today, there are 708 COVID patients in hospitals in Massachusetts and 143 in intensive care units. That compares to more than 3,500 patients with COVID hospitalized daily at the start of the pandemic in April 2020 and more than 2,000 patients a day last winter. 

But staffing has become constrained as health care clinicians become burned out over the long pandemic, and some cannot work due to illness, childcare, non-compliance with a vaccine mandate, or other issues. Labor shortages in various industries may have led to some clinicians switching jobs. In central Massachusetts, a lengthy nurses’ strike at St. Vincent Hospital has led to the closure of beds. According to the Baker administration, 500 beds have been closed due to staffing shortages during the pandemic. 

In addition, the state’s blanket prohibition on providing non-emergency care early in the pandemic combined with fear about exposure to COVID led many people to delay seeking needed medical care. Hospitals have been reporting that patients are now sicker by the time they arrive and many require longer hospital stays and more complex care. 

Health care experts say there is typically an influx of patients in the winter. This year, there could also be a rise in COVID due to holiday gatherings. 

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Shira Schoenberg

Reporter, CommonWealth

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.

“Our healthcare system and state leaders have done heroic work to mitigate this public health crisis over the past 20 months. But we are now seeing significant strain on hospital capacity due largely to workforce shortages and an influx of non-COVID-19 patients who deferred care and now need complex medical care,” Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association, said in a statement. Walsh said the trade association worked with Baker officials to develop the new order. 

Eric Dicksonthe Massachusetts Health & Hospital Association board chair and president and CEO of UMass Memorial Health, said in a statement, “While we recognize that delaying some prescheduled surgeries may present a significant hardship for patients, we believe it is a necessary step to assure that all of the Commonwealth’s hospitals can continue to meet the needs of patients requiring emergency care.”  

Although the COVID-19 state of emergency has been declared over in Massachusetts, Baker and the Public Health Council have retained authority under state law to issue emergency declarations to address the continuing threat of COVID. This order will be reviewed no later than January 31, 2022 to determine whether it can be rescinded.