How a Kitsap County Hospital Illustrates WA’s Urgent Care Crisis

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SILVERDALE, Kitsap County — Months of exhaustion in an emergency room here came to a head one night in early October.

“I had never seen such chaos,” said Kelsay Irby, an emergency room nurse at St. Michael Medical Center, a 262-bed hospital and one of the only ones serving the Kitsap Peninsula.

The waiting room filled up all day. Two children had high fevers and respiratory problems. Some patients were waiting with heart problems, others with low oxygen levels.

In his head, Irby ran through a list of relief options. But all the usual things that might have helped, like staff members available after hours or first responders from an ambulance company that serves the hospital, weren’t available.

She eventually called a non-emergency line at Kitsap 911 in desperation.

When two firefighters arrived to help guard the waiting room, Irby breathed a sigh of relief.

“I can’t say they prevented a catastrophe, but I know [they could have]”Irby said.

The frenzy that engulfed St. Michael’s ER on Saturday night was illustrative of the nationwide emergency care under strain as health care facilities grapple with too many patients and too few staff.

More than 30 emergency and health care associations across the United States called for federal support in a joint letter to President Joe Biden this month, detailing “breaking point” times in ERs across the country, including the incident at St. Michael.

Hospitals have largely attributed the crush of patients to delayed care during the pandemic, meaning their conditions have become more complicated. Skyrocketing rates of respiratory infections this fall have also contributed to a high volume of patients in Washington.

“I think the health care system realizes that we’re never going to have enough people,” said Chelene Whitaker, senior vice president of government affairs for the Washington State Hospital Association. “So we’re going to have to think about how to do things differently.”

St. Michael’s call for help on Saturday night sparked weeks of community action, prompting residents of the Kitsap Peninsula to pressure hospital leaders for solutions. A petition of defiance of St. Michael’s leadership has garnered over 1,000 signatures. Some long-time patients consider St. Michael to be their go-to place for care.

To make matters worse, a nationwide ransomware attack had hit St. Michael and its healthcare system, Virginia Mason Franciscan Health. For about two weeks, the hospital was unable to check patient records, histories, or lab refills online, while patients were unable to see their appointments, test results, and medical records. other electronic health records.

And the stress didn’t let up – on a recent weeknight, the hospital triggered proceedings for mass casualty incidents when a high number of emergency calls coincided with an emergency room already full.

“Best-case scenario you can be fully staffed, all the IT systems can be in place, and it can still be chaotic,” Irby said. “But when you take out the downtime and add the understaffing with a high level of patients, it really is a recipe for disaster.”

Wait times up across the region

ER volumes are rising at a time when hospitals are already well above capacity, state health care officials say.

In early November, hospitals in western Washington were forced to bed more than 900 patients in a week in non-traditional care spaces, like converted hallways and conference rooms, because all normal rooms were filled, according to Northwest Healthcare Response Network self-reported hospital data.

As ER volumes increase, so do wait times.

In October, about 13% of patients waited more than two hours for an emergency room bed in Providence Swedish, which has 10 emergency departments in the Puget Sound area. Some patients waited more than six hours, according to hospital system data.

In 2021, the median time it took to get a patient from the waiting room to a Swedish bed was around 12 minutes. Last week, the median time had risen to around 21 minutes. The hospital declined to provide average wait times and acknowledged they were “a bit longer”.

Other Seattle hospitals, like UW Medicine, are also experiencing long waits, and rural hospitals are often hit even harder, said Onora Lien, executive director of the Response Network, which connects hospitals and responders in emergency in Washington.

“St. Michael’s is not unique in terms of volume and reduced staff,” Lien said. “We are very aware of the current crisis within hospitals. And there have been quite significant impacts in the emergency room.

Hospital chiefs across the state are also speculating that people seem less familiar with the types of injuries or illnesses that require ER visits and that they may be more likely to show up for minor issues than they expect. were before the pandemic. In many situations, a call to a primary care provider or a visit to an urgent care clinic, depending on access, might be more appropriate and help shorten ER waits, said Whitaker, of the Washington State Hospital Association.

At St. Michael’s, only about 10% of ER patients are admitted to the hospital. But it can be a difficult balancing act, said Dr. David Weiss, the hospital’s associate chief medical officer. If a patient doesn’t know what to do in an emergency, they should definitely go to the hospital, he said.

“My biggest worry is that … they might be afraid to come in,” Weiss said. “For certain things, like if you have a critical and urgent condition, we provide exceptional care.”

Trust hangs in the balance

St. Michael’s leaders held a community meeting last month to try to retain the trust of staff and community members. Hospital President Chad Melton and other St. Michael’s leaders then reminded residents of the Kitsap Peninsula that labor shortages were widespread and said the hospital had “doubled down” on its recruitment efforts.

“We are working to identify strategies to decompress our emergency department,” Melton said later.

He also highlighted the recent increases during the summer contract negotiationsincentive programs and ongoing development efforts with Olympic College, but recruitment may be more difficult for more rural hospitals.

In response to the no-confidence petition, Melton said he had no plans to resign from his position.

Bremerton resident Beth Anderson, who attended the meeting, said she came away “depressed” and unhappy with some of Melton’s responses. The statistics Melton cited regarding ER wait times for urgent patients, in particular, angered her because they didn’t match her experiences.

She’s taken her dad to the ER countless times for various health issues, including three times in the last year. During a visit this summer, he waited three and a half hours for a room, then waited another two hours to see a doctor.

He had a UTI and COVID. He was also delirious and unable to walk, she said.

“The wait was a horrible experience,” she said. “They were so packed and both times my dad was in a lot of pain. … The staff was stressed and running around.

After his father was admitted, he ended up staying in the hospital for 10 days because he was so sick, Anderson said.

“I hope if it was a heart emergency they would act quickly, but I can tell you that you can get really sick and in incredible pain and wait for hours,” she said. “It was agonizing to see my father in so much pain.”

According to the hospital, patients with the most urgent needs who arrive by ambulance can get to bed within six minutes of arriving – and those with emergencies should still come to the hospital, Dr Griffith said. Blackmon, from St. Michael’s Medical Department. director of intensive care.

“Obviously we’d love to be able to treat everyone the second they walk through the door, but the reality is you have limited resources and you have to ask yourself, ‘How do you make sure you’re taking care of the people who really have the most acute, most life-threatening conditions?” Blackmon said. “And we haven’t seen any degradation in that regard.”

When Anderson’s father needed urgent medical attention last month, she instead took him to St. Anthony’s Hospital in Gig Harbor.

“The community is just at the mercy of this society,” she said later, acknowledging the limited hospital options she and her Kitsap County neighbors have. “We live near Silverdale, but I lack confidence in the emergency situation [at St. Michael]. If my husband has a problem, do I drive to Tacoma? »

Ask for help

Many community members in Silverdale, Bremerton, Port Orchard and other towns on the Kitsap Peninsula are still trying to find ways to support St. Michael’s employees.

“Nurses just don’t have the support or help they need,” said Sheila Murray, 67, of Poulsbo. “That’s why I want to go volunteer. I want to be part of the solution, not the problem. Even just being someone to help answer the phone or keep patients company.

Murray’s daughter worked as an emergency room nurse at St. Michael’s for more than 10 years, but left this year after running out, she said. Then, a few months ago, Murray’s husband was admitted to St. Michael’s and had to have gallbladder surgery, but had to wait because there weren’t enough staff.

“He was lying in his hospital bed for five days on morphine due to staffing issues,” she said. “I kept saying, ‘Can’t you send him home until you have the staff?’ And they told me he was too sick.

Murray and some of his neighbors are still hoping for change, but aren’t convinced there are many immediate solutions.

“We really care about this hospital,” Anderson said. “It’s really the only one we have. Where are we going if that’s no longer an option? »


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