Charting the Future of Hospitals (Lance Turner Editor’s Note)

This week’s Arkansas Business includes a special focus on the state’s hospitals, where doctors and nurses are in the fight of their lives, battling a pandemic that’s killed 7,600 Arkansans and continues to infect hundreds more each day. It’s been a slog.

After hospitalizations peaked at the start of the new year, they began a steep decline throughout the spring as more Arkansans became vaccine-eligible. By March, virus hospitalizations fell below 200, and the University of Arkansas for Medical Sciences closed its dedicated COVID-19 unit in Little Rock, returning nurses and physicians to their pre-pandemic stations.

At the time, UAMS Chief Nursing Officer Trenda Ray told THV 11 News she was “cautiously optimistic” and that normalcy seemed to be in reach. “You really do feel like there’s a ray of hope,” she said, “but at the same time, for us, we’re guarded.”

“We just need to take care of one another and take care of our community, so we all can get back to normal,” she said.

You know what happened next. After months with few new cases and low hospitalizations, COVID-19 returned with a vengeance to infect thousands of vaccine holdouts. In June, Arkansas began scaling nauseating new heights in active cases and hospitalizations, putting hospitals back into crisis mode.

During the first wave of COVID that peaked in January, Arkansas hospitals on Jan. 11 reported 1,371 hospitalizations. On Aug. 16, they hit a new high: 1,459.

Arkansas now appears to be on the back end of the second wave, with the seven-day rolling average of cases on the decline. Hospitalizations were below 1,000 as of Tuesday.

You might think things are looking up. Maybe they are. But doctors and nurses have been here before.

I’ve seen two world-changing events in my life so far: the 9/11 terrorist attacks and the COVID-19 pandemic. Like 9/11, the pandemic permanently changed our daily lives in ways big and small. Many of us are still figuring out exactly how.

For hospitals, the new normal is coming quickly into view. This week, Senior Editor Mark Friedman talks to hospital administrators to get a sense of the lessons learned and what the future holds for health care in a post-pandemic world.

Every part of the state is different, but you can see common threads in Friedman’s interviews:

Telemedicine: Video calls with your doctor are here to stay. Thanks to legislative tweaks, providers were able to implement telemedicine systems that will improve with time, and health insurers will adjust accordingly. UAMS Chancellor Cam Patterson says in our Executive Q&A that UAMS HealthNow has conducted more than 100,000 virtual patient visits since the pandemic began.

Nurse shortage: The nationwide shortage of nurses, bad before the pandemic, is worse. Vaccine mandates at hospitals are necessary and the right thing to do, but they’ll put more pressure on hospitals as some workers refuse the shot. In the long term, hospitals, education institutions and policymakers must place renewed focus on creating robust pipelines of nurses. How they’ll get there is unknown. CHI St. Vincent CEO Chad Aduddell tells Friedman that it will take a comprehensive effort to find new ways to promote health care careers to students as early as possible.

Waiting rooms: Looking back, getting on an airplane anytime before Sept. 11, 2001, was a shockingly casual affair. We’ll soon reflect on pre-COVID crowds of ailing people, crammed together in physician waiting rooms or hospital ERs, in a similar state of disbelief. Administrators tell Friedman that most patients will wait in their vehicles before appointments, much the same way we await our deliveries in the grocery store parking lot.

Mental health and wellness: The COVID-19 strain on health care professionals has been immense. Patterson and other administrators have seen nurses walk off the job in the middle of their shift, unable to take it anymore. In 2018, Friedman wrote about suicides among physicians; his work this week suggests suicidal thoughts have dogged some nurses amid the pandemic. Now an emphasis on mental health will take center stage, particularly as hospitals do all they can to retain hard-to-come-by frontline employees. (Assistant Editor Marty Cook has more in After 18 Months of 12-Hour Days, ‘We’re Tired’.)

Given these changes and new opportunities to strengthen the workforce, there’s reason to be optimistic that this COVID crucible forges a health care system better prepared for tomorrow’s challenges. Hospitals are laying the groundwork as best they can.

Lance Turner is the editor of Arkansas Business.