On health care front lines, we are not OK

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I am a hospital doctor and medical staff leader, and have worked extensively over the past two years with critical care experts and others in trying to provide appropriate medical care for Minnesotans. We are worried.

While health care teams are indeed grateful for the decline in numbers of influenza patients recently reported in this paper, our challenges with "limited bed space and overcrowded emergency departments" nevertheless persist and continue to severely hamper our ability to provide needed care. ("Decline in flu cases frees up hospital beds," Dec. 30.)

If you've recently been hospitalized or had someone close to you with a serious illness or debility, you witnessed firsthand long delays in the ER, delays in hospital discharge, or an inability to get to a larger medical center from a rural area for much-needed complex medical care — just a few of the challenges patients, families and health systems are facing. At a regional level, since the beginning of the pandemic we have also lost a significant portion (roughly 20%) of our capacity to provide hospital and rehabilitative care (in nursing homes or similar facilities).

The reasons for this are complex. Overextended nurses and other team members have either left their profession altogether or transitioned to higher paying, and often less stressful, contract work. Working at nursing homes or rehab facilities is hard, pays poorly, and is often unappreciated if not outright criticized by patients, families and others.

Thousands of open positions in hospital and post-acute settings are currently unfilled in Minnesota, and the situation does not show signs of improvement.

Given these staffing shortages, we are unable to access nursing home or non-hospital mental health supportive care for unprecedented numbers of hospitalized patients. As a result, patients who should be discharged from hospitals to nursing homes for ongoing supportive care or to continue their recovery remain in hospitals much longer than necessary.

This means we have fewer beds for patients who need to be admitted to hospitals, including from our emergency departments. Similar barriers hamper access to mental health care, so patients needing such care also remain in our emergency rooms and hospital units.

These backlogs impact the quality of care that we can provide our patients in these settings, and result in unnecessary suffering for them. Additionally, when urban medical centers are overtaxed in this way, they are unable to accept patients from rural settings with severe conditions that require specialty care.

These challenges also result in increased burnout for health care professionals. The strain is especially severe in emergency rooms, which are required by law to provide care for all patients who come in, and have been routinely overwhelmed over the past 18 months. Nearly all emergency room physicians currently are burned out, and many have left or are considering leaving the profession due in part to these conditions. For nurses and other staff, it is the same or worse.

This sets up a vicious cycle, with further impacts on staffing and overcrowding of health care facilities.

We are not OK, and we cannot fix this alone. We are deeply concerned about the health of Minnesotans and the well-being of our health care workers.

How can you help?

In the short-term, adding support for longer term management of those unable to return home after hospitalization must be a priority for our elected officials. In the longer term, our community has work to do ensuring that those most vulnerable among us have a safe place to go, whether that is more support at home — or in a facility. We need your help.

Also, please be kind to those on the front lines who chose their health care careers because they want to help people. Use your primary care system as much as possible and only use emergency rooms and urgent care for emergencies. If you need urgent care, be patient with emergency room and hospital teams, most of whom have been working above a sustainable work capacity for many months.

Get your flu shot and COVID vaccines. These are simple steps to help avoid becoming another person who needs scarce hospital resources. We need your help.

Have you considered a career in health care? We need your help.

And finally, encourage your local and state representatives to lean into this crisis and consider getting involved. We need your help.

Tom Klemond is a physician and vice president of medical affairs, Hennepin Healthcare. He is a member of the Minnesota Critical Care Working Group.