“Persistently high volumes”: The view from inside a hospital

 

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“Persistently high volumes”: The view from inside a hospital   September 14, 2025 By Paul Hattis

When COVID arrived, in March of 2020, Dr. Paul Hattis and Dr. Jarone Lee, a critical care and emergency medicine physician at Massachusetts General Hospital, started a series for CommonWealth Beacon of what came to be more than a dozen interviews during the initial years of the pandemic. (You can read more here.) It has been about two and half years since their last Q&A posting. Hattis, a former professor at Tufts University Medical School and currently a fellow at the Lown Institute, decided to have a check-in discussion with Lee to see what his world is like these days and what sort of longer lasting impact Covid has had on it. This conversation has been edited for clarity.

HATTIS: What has happened to inpatient volumes, including ICU volumes since the Covid era peak?

LEE: Overall, at MGB [Mass General Brigham], ever since COVID arrived, our emergency department, inpatient, and ICU units continue to run persistently high volumes, both at our academic centers and community hospitals. Previously, on the ICU side, high volume months were often more predictable, with summer bringing higher numbers of trauma patients, and wintertime often with higher respiratory virus cases. However, these days, we continuously have a high volume of high-acuity patients year-round.  I think a key contributing factor is that many of the smaller hospitals have less staffed beds and reduced ability to care for very sick patients.

I do believe this is worse since the pandemic, and the accompanying era of rising health care supply and labor costs, nursing shortages, and difficulty keeping needed subspecialists on staff. For example, at many hospitals, if a patient arrives at a hospital without a neurosurgeon and has a head injury with blood around the brain, they will need to transfer to a system like ours.

HATTIS: What would you say has happened with stress and burnout in the last couple of years? Is it better than things were during the height of Covid?

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LEE: I wish I could say that stress and burnout has started to decline, but burnout continues to be high among doctors, nurses, and allied health staff working in all of our clinical settings, ranging from emergency departments and ICUs to our outpatient clinics and services. I am hopeful that one of the silver linings of COVID is an increasing focus on the mental health of health care workers. I do feel like there has been a more concerted effort to figure out how to make things better – despite knowing that there is a need for a wide variety of strategies to address the problem.

Another good sign is that I recently encountered a new starting group of residents in the ICU who were not yet exposed to intense Covid care situations during their clinical training years. Why I bring this up is that they were all extremely energetic, engaged in learning about medicine [and] the hospital, and in exploring what happened during the initial years of the Covid era. I am excited to follow their journeys, and I believe their high energy and interest will continue to help with the overall environment.

HATTIS: Of course, people still get Covid infections today and get hospitalized. Some are very ill. Do survival rates of ICU patients with Covid seem any different now than when you had many cases?

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LEE: People continue to get Covid, and we continue to have patients that get admitted to the hospital and the ICU with COVID-related complications, including respiratory failure that requires mechanical ventilation. As a medical community, we learned a ton about how to treat not only Covid, but diseases like acute respiratory distress syndrome (ARDS), which you can get from COVID. Similarly, we learned an incredible amount about how to use advanced, non-invasive oxygenation devices, such as high-flow nasal cannulas, safely and effectively to reduce the need for mechanical ventilation. COVID continues to have lingering effects, including many patients with long COVID, who continue to suffer a wide variety of symptoms.

HATTIS: Do you have any specific concerns going into this next winter respiratory viral season?

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LEE: Traditionally, flu season occurred near winter, and we saw an uptick of flu cases in the hospital and in our ICUs; however, this last year, we noticed a second peak around February. The reasons are unclear, but we do know that flu, COVID , and other respiratory diseases continue to cause critical illness in patients requiring admission to the ICUs. As strongly suggested by groups such as the American College of Physicians and the American Academy of Pediatrics,  I would reinforce the need to get annual vaccinations as that helps protect our patients from the uncommon – but very real – chance of dying from the flu or other viruses. This is especially true for our elderly, young, and immunosuppressed, such as cancer patients.

HATTIS: The affordability challenges of US health care are significant and ubiquitous across our country and in our state.   One hope to make some progress here is to reduce the operational expense growth faced by our health care providers.   There is a lot of hype and hope that the uses of artificial intelligence can bring real and meaningful savings to health care operations.  From a bedside clinician’s perspective, are there any tangible examples you can point to right now of how AI is already helping to save money and what sort of hopes do you have for it going forward into the future?

LEE: AI is everywhere. I cannot go through a day at the hospital without someone, patient or colleague, bringing up AI and how it is changing health care. I fully agree with your sentiment that AI, deployed properly and with the correct guardrails, will lead to much better patient outcomes, improved back-of-house processes, and,  hopefully, greatly reduce much of the busy work that leads to burnout and stress.

For example, across MGB, we recently deployed an AI-based documentation system that supports one of the most painful parts of my personal workflow – writing patient notes. While I love the HBO TV show “The  Pitt” and how medically accurate it is to our clinical lives, what my colleagues and I joke about is that the clinicians in the show are not seen doing the many hours of documentation required for the vast numbers of patients they see.  Employing AI to help clinicians with their documentation burden by listening to our conversations with patients and then generating a note that we can review and modify after a patient encounter is already starting to be a time game-changer, and only one of many opportunities for AI in the health care space.

HATTIS: You are also leading on some of MGB’s international partnerships, in particular you’re working to build a hospital in a part of the UAE that lacks health care facilities. You also continue, through your volunteer efforts, to try to support health care workers in Ukraine and other places through telehealth. Any reflections from these efforts that you think would be of interest to a Massachusetts audience?

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LEE: Yes, I lead a project where we are supporting the build of a new hospital in a rural and underserved area of the UAE. It’s an incredible project that I am excited about both in terms of mission and breadth as we are working with an incredible local partner. Similarly, the non-profit that I volunteer with primarily, Health Tech Without Borders, continues to serve and offer support in needed countries, with a good amount of effort in Ukraine. We recently deployed a new telehealth system to Dnipro, in Eastern Ukraine, near the front lines. It has already started helping to reduce the number of children needing to be transported — avoiding more danger for these kids needing to travel between hospitals.

Interestingly, during a recent check-in with the Dnipro team, they shared that with the recent uptick in attacks in Western Ukraine, they are now supporting traumatically injured kids in Kyiv as they have had much more experience within Dnipro. What is even more interesting is that they have been using the system to support telehealth, outpatient visits for their regular population of patients, across all specialties from pediatrics to cardiology and more. This just shows how telehealth is the future and can scale rapidly even in conflict zones.

HATTIS: During the height of the pandemic, we also talked about how your family was doing – especially your then-5-year-old son – while you were devoting enormously long days to the frontlines of patient care. How’s your family doing these days?

LEE: Thank you for asking. My family is doing well. Our son enjoyed his time out of school this summer. He is now his own person with his own personality and knows what gets me. I always know when he is mad at me because he will tell me that my jokes are not funny.

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