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

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

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

The waiting room was crowded all day. A couple of children had a high fever and breathing 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 off-duty staff or first responders from an ambulance company that serves the hospital, weren’t available.

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

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

“I cannot say that they prevented some catastrophe, but I know [they could have]”, said Irby.

The frenzy that gripped the St. Michael that Saturday night was illustrative of emergency care across the country under strain as health facilities deal with too many patients and too few staff.

More than 30 U.S. emergency and health care associations urged federal support in a joint letter to President Joe Biden this month, detailing “breaking point” moments in emergency rooms across the country, including the incident in St.

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

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

The cry for help from St. Michael that Saturday night sparked weeks of community action, prompting Kitsap Peninsula residents to press hospital executives for solutions. A censure petition to the leaders of St. Michael has collected over 1,000 signatures. Some longtime patients are reconsidering St. Michael as your place of care.To make matters worse, a nationwide ransomware attack hit St. Michael and his health system, Virginia Mason Franciscan Health. For about two weeks, the hospital was unable to check medical records, history or lab refills online, while patients were blocked from seeing their appointments, test results and other electronic health records.

And the stress hasn’t eased — on a recent weeknight, the hospital activated procedures for mass casualty incidents when a large number of emergency calls coincided with an already full ER.

“At best, you can have a full team, all the computer systems can be up and running, and it can still be chaotic,” Irby said. “But when you throw away the downtime and add understaffing with a high level of patients, it really is a recipe for disaster.”

Wait times across the region

Emergency volumes are rising at a time when hospitals are already over capacity, state health leaders say.

Western Washington hospitals in early November were forced to house more than 900 patients in a week in nontraditional care spaces, such as converted hallways and conference rooms, because all regular rooms were full, according to hospital data. reported by the Northwest Healthcare Response Network.

As ER volumes increase, so do waiting times.

In October, about 13% of patients waited more than two hours to get an emergency bed at Providence Sweden, which has 10 emergency departments in the Puget Sound region. Some patients waited more than six hours, according to data from the hospital system.

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

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

“St. Michael’s is not unique in terms of volume and small staff,” said Lien. “We are very aware of the ongoing crisis in hospitals. And there have been some pretty significant impacts in the ER.”

Hospital leaders across the state also speculate that people seem to be less familiar with the types of injuries or illnesses that require emergency room visits and may be more likely to look for minor problems than they 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, may be more appropriate and help reduce emergency room waits, said Whitaker of the Washington State Hospital Association. .

at St. Michael’s, only about 10% of emergency room patients are admitted to the hospital. But it can be a difficult balance, said Dr. David Weiss, the hospital’s associate medical director. If a patient is not sure what to do in an urgent situation, they should definitely go to the hospital, he said.

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

Trust is in the balance

The leaders of St. Michael’s held a community meeting last month in an attempt to maintain employee and community trust. Hospital President Chad Melton and other St. Michael reminded residents of the Kitsap Peninsula that workforce shortages are widespread and said the hospital has “redoubled” its recruitment efforts.

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

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

In response to the no-confidence petition, Melton said he has no plans to step down.

Bremerton resident Beth Anderson, who attended the meeting, said she left feeling “depressed” and dissatisfied with some of Melton’s responses. The statistics Melton cited about emergency room wait times for urgent patients, in particular, irritated her because they didn’t match her experiences.

She has taken her father to the ER numerous times for various health issues, including three times in the past year. On one visit this summer, he waited three and a half hours to get a room, then waited another two to see a doctor.

He had a urinary tract infection and COVID. He was also delirious and unable to walk, she said.

“The wait was a horrible experience,” she said. “They were so crowded and both times my dad was in so much pain. … The crew was all stressed out and running around.

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

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

According to the hospital, patients with more urgent needs arriving by ambulance can go to bed within six minutes of arrival — and those with emergencies must still go to the hospital, said Dr. Griffith Blackmon, physician at St. director of intensive care.

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

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

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

Asking 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.

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

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

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

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

“We care deeply about this hospital,” Anderson said. “It’s really the only one we have. Where do we go if it is no longer an option?”

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

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