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Washington health officials hope to avoid crisis standards of care, as hospitals stretch capacity

UPDATED: Wed., Sept. 15, 2021

With North Idaho hospitals already rationing care under stress from the influx of COVID-19 patients, Washington health leaders are making preparations in case they need to do the same.

Health officials said the stress felt in the state’s health care system could continue for days or even weeks.

Hospitals around Washington are expanding their intensive care units into nontraditional settings, emergency departments remain backed up with patients and COVID patients are delaying other necessary health care, including surgeries to remove cancerous tumors.

Since July 1, the Washington Medical Coordination Center has received more than 1,000 requests from hospitals to transfer patients elsewhere, especially from rural hospitals where patients are typically stabilized before they are transferred elsewhere for intensive care.

“We’re doing everything we can, so we don’t stretch that system to the point it breaks and we have to implement crisis standards of care,” Secretary of Health Dr. Umair Shah said on Wednesday.

How crisis standards of care will work in WashingtonThe state of Idaho has declared crisis standards of care in North and north-central Idaho already, but in Washington the process is slightly different.

A declaration of crisis standards of care would allow hospitals to ration care, lowering the level of care some patients receive.

Shah said if needed, crisis standards of care declaration in Washington likely would be done statewide, not regionally.

This is, in part, due to the medical coordination happening among hospitals statewide. All hospitals in Washington have agreed to take on patients from other facilities to keep all facilities operating and surging at similar levels.

The Washington Disaster Medical Advisory Committee, made up of health care providers and groups from around the state, is meeting to assess how stressed the state’s health care system is.

If the committee recommends declaring crisis standards, Shah would review the recommendation with Department of Health staff and the governor’s office to declare crisis standards statewide. While he said it’s not completely off the table, Shah does not envision declaring crisis standards in just one region of the state.

“I am really concerned we’ve stretched this rubber band (of the health care system capacity), and at some point that band will break,” he added.

How tight local hospitals areSpokane hospitals are creating capacity in their own facilities by expanding intensive care units and diverting surgical staff to medical and intensive care floors.

At Providence Sacred Heart Medical Center, there are 54 ICU beds, and 18 of those beds are filled with COVID patients on ventilators. All are unvaccinated, Dr. Dan Getz, chief medical officer at Providence Spokane, told reporters Wednesday.

Providence is looking to expand its ICU capacity as demand continues to grow, and Getz said there were 17 patients on other floors who could have been in the ICU had there been room. Hospital officials are considering opening a post-operation recovery area of the hospital to treat less intensive COVID patients and free up more space for ICU capacity.

Providence canceled elective and non-emergency surgeries this week diverting roughly 50 surgical team members to other parts of the hospital, Getz said.

COVID hospitalizations are at an all-time high in Spokane County hospitals, and the ripple effects to other parts of the health care system are being felt more intensely.

Getz said cancer removals and orthopedic procedures that would relieve pain for the patients seeking those treatments have been delayed due to the surge.

“This is unchartered territory,” Getz said. “We’ve never had to do this.”

Typically, Sacred Heart Medical Center, a hub for regional transfers, accepts about 90% of transfer requests. Now that number is closer to 50% or lower.

This means some rural facilities might be left to look elsewhere to transfer a patient. Getz said in some cases Providence physicians are talking to rural providers by phone to guide them to do care they usually don’t have to provide .

Staffing is the biggest challenge faced by hospitals, not only in Spokane but statewide.

Resources in high demandProvidence Spokane has requested approximately 200 staff including nurses, respiratory therapists and medical assistants from the Department of Health. Statewide, other hospitals are making similar requests.

Shah told reporters that the Department of Health has requested 1,200 personnel presumably through the federal government, although the department could not provide further details Wednesday.

Locally, Getz said Providence has attempted to hire traveling nurses, who are in incredibly high demand.

“We’re paying very high rates and trying to recruit as much as we can,” he said.

Staffing is a challenge not only in Washington but nationally.

A shortage of staff also has led to a shortage in testing resources and supplies.

CHAS, which previously offered drive-up testing, does not have the staff to open a similar site again. Instead, CHAS health clinics are offering people mail-in testing for the virus instead of in-person testing on-site.

Those seeking testing do not have to be a CHAS patient to get a mail-in test.

The Spokane Regional Health District has requested testing support from the Department of Health. Interim Health Officer Dr. Francisco Velázquez said there could be smaller, kiosk-like testing sites deployed by the department or a mass testing site.

The district still is waiting to hear from the department on what support is available for either of those community testing strategies.

Here’s a look at local numbers:

The Spokane Regional Health District reported 248 new COVID-19 cases on Wednesday and four additional deaths.

There have been 794 deaths due to COVID-19 in Spokane County residents.

There are 236 patients hospitalized with the virus in Spokane hospitals.

The Panhandle Health District confirmed 277 new COVID-19 cases and 17 additional deaths.

There have been 398 deaths due to COVID-19 in Panhandle residents.

There are 105 Panhandle residents hospitalized with the virus.

Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

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