WORCESTER — Elective surgeries at UMass Memorial Medical Center were canceled a week ago because no hospital beds were available for patients, in or out of the UMass Memorial network.

Over the holidays, the UMass Memorial pediatric intensive care unit was closed for a few days because it was full.

Patients at St. Vincent Hospital have been waiting at times on stretchers in emergency department hallways because beds were backed up.

"It is unusually full in almost all of the Central Massachusetts hospitals," Dr. Michael P. Hirsh, medical director for the Worcester Division of Public Health, said this week. Dr. Hirsh is also the surgeon-in-chief at UMass Memorial's Children's Medical Center.

When critical bed shortages occur, emergency care comes first and rooms morph from post-operative recovery units to intensive care overflow; patients are boarded in triage observation units and emergency departments; and doctors and nurses treat patients wherever they may be, Dr. Hirsh said.

Winter typically brings more hospital admissions, but with a flu strain hitting hard and later than predicted — and for which the available vaccine is only 23 percent effective — as well as a raging upper respiratory virus going around, hospitals have had to stretch their resources to meet the load of sick patients.

Hospital officials maintain that with flexible use of space and staff, inpatient care has not been affected. But a nurses union spokesman says the occupancy pressure compromises patient safety and the union has called for legislation to mandate staff-to-patient ratios across all hospital departments.

"Absolutely we are seeing increased admissions related to flu," said Steven MacLauchlan, president and CEO of St. Vincent Hospital. "I've got some open space in labor and delivery, but that's not that helpful."

Mr. MacLauchlan said clinical teams meet multiple times a day and receive pager blasts and updates about allocating care to where it's needed most.

Hospital staff members are also working closely with community agencies to arrange services promptly for after patients are discharged.

"It's kind of a full-court press," Mr. MacLauchlan said.

He said even if patients are on stretchers in hallways, they are getting treatment started right away.

At UMass Memorial's University and Memorial campuses, hospital admissions have been slightly elevated for the last six or seven months, according to Patrick Muldoon, UMass Memorial Medical Center president.

He said demand is up throughout the hospital, from the emergency department to medical-surgical floors to outpatient services.

UMass Memorial has 779 licensed beds, and is currently approved to use 663 of those. Its recent annual utilization data show 38,403 admissions, not including newborns, and 134,891 emergency visits.

A new 26-bed unit was set to partially open this week, according to Mr. Muldoon, which would offer more space. The hospital planned to recruit nurses and other staff to cover the unit.

Mr. Muldoon said even if beds are full, the hospital is alerted to patients coming in by ambulance and can quickly plan for treatment.

"People are mustering to the area," he said. "If they need to be seen immediately, they are seen immediately."

"We have to move resources to wherever those patients are," said Dr. Richard M. Forster, chief of the division of hospital medicine at UMass Memorial. "We do transfer patients on a regular basis from the University hospital, which is frequently overfilled, to the Memorial hospital, which is often underfilled. Except last week Memorial was also filled."

Dr. Forster added, "Staff have really kicked it up a notch in a time that's stressful."

Mr. Muldoon said the medical center keeps staffing up to meet patient volume by bringing in more per-diem nurses, travelers and overtime.

"Regardless of the census we will maintain a safe staffing level," he stressed. "We have a plan in place that takes care of these emergencies."

Massachusetts Nurses Association spokesman David J. Schildmeier disagreed that hospitals were safely staffed for the increased volume of patients.

"We are not prepared for patient census on a daily basis, so when things hit the fan like they have recently, it's devastating," he said. "At UMass in particular, they've been gutting staffing levels."

Mr. Schildmeier said MNA representatives met recently with Dr. Eric Dickson, president and CEO of UMass Memorial Health Care, to plead their case.

"Nurses are working faster and harder trying to place patients. Hospitals are floating nurses from one unit to another. I can't emphasize how understaffed hospitals are," he said.

The MNA filed a bill this week, An Act Relative to Patient Safety, that aims to improve patient safety by setting a limit on the number of patients assigned to a nurse at one time, while providing hospitals with the flexibility to adjust staffing based on patients' needs. The patient-staffing ratios would apply to all units of the hospital, Mr. Schildmeier said.

He pointed to a recent report from the U.S. Centers for Disease Control and Prevention that showed Massachusetts ranked fourth worst in the country for catheter-associated central line infections, and another national study in which the state was fourth worst in hospital readmissions, which he said were directly tied to understaffing of nurses.

Meanwhile, Dr. Hirsh said everyone can watch out for their own health by following basic hygiene to reduce the spread of flu and other viruses. That means washing hands frequently, using bacteria-killing soap on kitchen and bathroom surfaces and staying home when sick.

Dr. Hirsh and others encouraged people to get the flu vaccine, even though it's not completely effective against this year's strain.

"Most infectious disease experts still feel it imbues some immunity protection," Dr. Hirsh said.

Original Article: http://www.telegram.com/article/20150122/NEWS/301229546/1116