Health care professionals who have turned to a central transfer center implemented to help get the sickest Nebraskans the care they need say the system isn't working as well as needed.
Gov. Pete Ricketts on Sept. 1 brought back the transfer center, a central clearinghouse for finding available hospital beds, as COVID-19 hospitalizations continued to rise.
The transfer center had first been used last year, with a fair amount of success, as hospitals in the state's more rural areas were able to find beds in the state's larger facilities for often critically ill COVID-19 patients.
That transfer center was run by CHI Health. The version brought back this month is being run by Nomi Health, the Utah-based company that ran COVID-19 testing operations for the state until earlier this summer.
The previous central transfer center focused mostly on finding beds for COVID-19 patients. The new version aims to find beds for any patient, but that's proven a challenge for those most in need of care.
Last week, during a media briefing, Bryan Health officials said the transfer center was not proving helpful in cases where very sick patients who were not stable needed to get to a larger hospital.
"The ability to transfer unstable patients is not there," said Bob Ravenscroft, Bryan's vice president of advancement.
Ricketts said Monday that no hospital CEOs have contacted him about problems with the transfer center.
However, Dr. Gary Anthone, the state's chief medical officer, said he was aware of concerns regarding the ability to transfer unstable patients, and he said there may be "some upcoming news" regarding that issue.
On Wednesday, the Nebraska Department of Health and Human Services said in a statement that the transfer center "continues to work with Nebraska medical facilities to ensure safe transport and adherence to the requirements that have been outlined to the providers."
The statement also said that a working group of coalitions, facilities, subject matter experts, NOMI and DHHS has been created to "address needs and feedback with the transfer center as well as to enhance standard operating procedures for operations going forward."
Dr. Kevin Reichmuth, a Lincoln pulmonologist, said part of the problem is that the hospitals in Lincoln and Omaha, which have more specialists available and offer the highest levels of care, are generally full.
"We live at the edge of hospital capacity literally every day," said Reichmuth, who treats patients at both Bryan and CHI St. Elizabeth in Lincoln.
As of Wednesday, there were 425 adult COVID-19 patients in the state's hospitals, according to the dashboard that Ricketts reinstated on Monday. More than a quarter of those patients, 119, were in intensive care.
But there also were nearly 2,300 adult patients and more than 200 pediatric patients in hospitals across the state for other reasons.
In addition, because of staffing shortages, the number of beds available for all those patients had dropped below 3,900 as of Wednesday, down from more than 4,200 last fall.
Many smaller hospitals have beds available, but when patients come in with medical needs the small facilities are not equipped to handle, a transfer becomes necessary.
Dr. Pete Lueninghoener, a family physician in O'Neill, said it's those kinds of cases he expected the transfer center could help with, but so far, that's not been the case.
Lueninghoener discussed the case of a patient who came into Avera St. Anthony's in O'Neill on Sept. 10 with a perforated bowel. Knowing the patient needed to be transferred immediately, staff there called the transfer center, but no one answered, he said.
Staff wound up making calls themselves -- 11 in all -- before finding a hospital with an available surgeon and an open intensive-care bed for the patient.
All the while, a medical helicopter waiting to transport the patient was tied up for hours.
"It was approximately four hours that the person had to wait to find an ICU bed capable of handling her case," Lueninghoener said. "She could have very easily died in our emergency department waiting for a bed to become available."
In another instance last week, he said O'Neill hospital called the transfer center trying to find a hospital for an unvaccinated COVID-19 patient who started to rapidly go downhill.
Staff did reach someone at the transfer center, but Lueninghoener said the person had no idea where O'Neill was.
"My impression was that he was definitely not located in our state and there was a good possibility that he was not even located in our country," he said.
In that case, Lueninghoener said the hospital could not find an open bed for the patient and wound up having to intubate him. He was transferred a day later.
Lueninghoener said the O'Neill hospital also worked with a call center in South Dakota, where its owner, Avera Health, is based. While staff there couldn't find an open bed either, they were at least helpful and checked in often to offer updates on the bed situation, he said.
"We never heard back from the Nebraska call center after the initial contact," Lueninghoener said.
Reichmuth said situations like the one in O'Neill appear to be common. He said he's heard stories of many small hospitals having to make anywhere from 10 to 20 calls on their own trying to find open beds because the transfer center could not help them.
Dr. Robert Wergin, a physician affiliated with Seward's Memorial Healthcare Systems, said the hospital there has a strong working relationship with Bryan and he prefers to call there directly to see if he can find an open bed.
However, that doesn't always work these days, as Bryan often has no beds open.
Wergin said he has resorted to using the transfer center, and while he found staff there to be cordial and helpful, they were often unable to fulfill his request.
"I think it worked pretty smoothly, I just think there were no beds," he said.
Wergin said he's had to keep three or four patients at the hospital in the past couple of weeks that he would have normally transferred. In a couple of cases, he was eventually able to move them to Bryan after beds came open. In the others, the patients improved while at the Seward hospital and were able to go home.
While the outcomes were good, he said the situation pushed the hospital "to the limits of our infrastructure, equipment and staff."
"You just do what you have to do to take care of the patient," Wergin said.
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