WA state hospitals remain over capacity, and it’s not just the fault of COVID-19
Washington hospital officials on Monday sounded the alarm again about the state’s ever-shrinking bed capacity for patients, blamed not entirely on the COVID-19 pandemic but rather problems that have plagued the system for most of the year.
Lack of staff, both in hospitals and at skilled nursing facilities, and a growing number of difficult-to-discharge patients are leaving hospitals in a constant state of overcapacity with too few beds for acute care, according to Washington State Hospital Association leaders and various hospital representatives who spoke to reporters Monday.
The same problems were addressed at length at the association’s briefings in December and January. Since that time, the problems have only increased, officials say.
Dr. Steve Mitchell, medical director for the Washington Medical Coordination Center, said that hospitals in King, Pierce and Snohomish counties “are more strained today than really at any other point since the pandemic began.”
Tacoma-based MultiCare is no exception. Dr. David O’Brien, senior vice president and chief executive for MultiCare South Sound Region, said that hospitals in the area “have been operating at over 100 percent capacity for months,” with about 180 patients stuck in hospitals, unable to discharge because of either lack of capacity at skilled care facilities, or guardianship issues.
If a patient has not appointed a decision maker in a power of attorney document, the only option is a court-appointed guardian, which takes time, according to state interpretation of the law.
A bill that was introduced in Washington state Legislature that would have eased the guardianship rules for transfer didn’t go beyond a public hearing in the House Committee on Civil Rights & Judiciary, according to the state’s online bill tracker, and health officials are trying to educate the public on why their next visit with a doctor in the emergency department might take place in the hospital lobby or a conference room.
Steve Brooks is chief of Lacey Fire District 3 and president of the Washington State Fire Chief’s Association. Brooks said Monday’s briefing, in which he participated, helped him learn more about “throughput challenges” that result in patients being parked in ambulances awaiting admission.
“The time for transfer or offloading .... I think the record I’ve heard of in my community so far is about 4-1/2 hours,” he said, because there was not inpatient capacity.
“In our region, we’re seeing that routinely that type of the normal capacity of an emergency department is actually taken up” by patients that would normally be in a room. “That is becoming very common practice,” he said.
Taya Briley, Washington State Hospital Association executive vice president, told reporters that they are calling for more temporary, rapid response teams much like used by the state earlier in the pandemic for understaffed care facilities that could help clear some of the backlog, along with other measures. The teams in the past were contracted by the Department of Social and Health Services, hiring from temporary nursing agencies using $1.3 million in CARES Act funding.
She and others made clear the guardianship rules for transfers remain a significant hurdle.
In the meantime, officials such as Dr. Nathan Schlicher, past president of the Washington State Medical Association and a practicing emergency department physician at St. Joseph Medical Center, implored people to stay safe through the summer.
“The return to life has produced more trauma,” he said, with accidents, gun violence and more, “and we’re seeing increasing pressure on the system.”
He added, “We need help from Olympia and from our leaders to get folks out of the building. Because if overnight we got those 10-20 percent of folks staying in our building out .... our capacity would be a very different conversation, and I might actually get to care for you in an ER bed again, not just the hallway.”
The pandemic’s upending of routine surgeries and the resulting delayed care, additional labor cost to pay for traveling health care staff and supply-chain disruptions have all put financial strains on medical systems, the officials noted Monday.
O’Brien said MultiCare’s reliance on more than 1,000 travelers “comes at a financial premium.” Combined with inflation costs of supplies, the system’s operating loss has been $194 million so far this year.
“This is really an unsustainable situation where we’re seeing increased demand, significant capacity issues that are being amplified by some of the financial challenges,” O’Brien said.
While COVID remains an issue, Schlicher described what hospitals are facing as “death by 1,000 cuts.”
“It is the small number of COVID patients that we are seeing, it is the 10- to 20-percent long-term stay patients that can be treated somewhere else,” Schlicher said. “It’s the potential of the one or two monkeypox cases down the road. But there’s not a single silver bullet. We need to tackle all of these issues together.”
The hospital association said it is planning another briefing later this week focusing on the financial hits hospitals have taken.
Story has been updated with MultiCare’s operating loss total so far this year. An earlier amount stated at Monday’s news briefing was for all losses.
This story was originally published July 18, 2022 at 2:07 PM.
