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Washington hospitals hoping to avoid crisis standards of care

Providence Sacred Heart Medical Center.  (Jesse Tinsley/THE SPOKESMAN-REVIEW)

Despite the repetitive nature of things being “unprecedented” for hospitals and the health care system during a nearly two-year long pandemic, many hospital and health care administrators statewide are especially concerned about the next few weeks.

This is the worst it has been for myriad reasons for hospitals across the state, and it’s not all due to current COVID cases, but more as a result of wave after wave of COVID, loss of staff and now a variant so contagious that fully vaccinated staff are getting sick and have to stay home from work.

As of last Thursday, hospitals are at 94% occupancy statewide, and people with COVID-19 make up 21% of patients in hospitals. That figure is rising, squeezing and putting pressure on hospitals full of people who need beds after undergoing delayed surgeries or needing emergent care.

Hospital occupancy has been high in the last year in Washington, but it reached new levels during the delta variant surge last fall. Hospitals have been at or above 90% occupancy since September.

As a result, health care workers are tired, and now they are also at-risk with the rest of community members for testing positive with omicron, which is more transmissible.

Last week, Gov. Jay Inslee took action to hopefully stave off what is known as crisis standards of care being declared. In Washington, crisis standards of care are declared statewide by the secretary of health when ventilators or hospital beds have to be rationed.

The state is not at this point, and the governor canceled all non-urgent surgeries and procedures in the next four weeks to hopefully avoid this declaration. This doesn’t mean that hospitals are operating normally, however. Crisis standards in staffing, for example, do not require a statewide declaration, and hospitals can move in and out of these protocols.

Hospitals are moving from contingency to crisis staffing models routinely, depending on how many staff are available to care for patients. Crisis staffing models mean a hospital deviates from its typical patterns due to lack of staff or demand for services, Taya Briley, vice president of the Washington State Hospital Association, said last week.

“Hospitals operating at these levels will mean longer wait times,” Briley said.

Briley said crisis staffing could also mean that some services, such as COVID testing, will not be offered and that staff may return to work sooner than they previously would have when they are exposed to COVID-19.

Hospitals operate in conventional, contingency or crisis standards, and the Centers for Disease Control and Prevention released new guidelines for when health care workers can return to work based on the hospital’s status.

The guidelines allow hospitals operating in crisis standards to bring back staff who have tested positive for COVID-19 and are mildly symptomatic or asymptomatic with no restrictions, while hospitals in contingency standards should have employees wait for five days before they return to work with a negative test or improving symptoms. Some hospitals are implementing this guidance when they need to, hospital leaders said last week.

The difference between contingency and crisis standards can be tricky to discern, Adam Richards, chief nursing officer at Providence Holy Family Hospital, said.

“We look at staffing every single day and make sure we do have enough staff,” Richards said. “There’s a difference between a crisis of a moment between shifts, and being without staff for a long time – that’s a true crisis.”

Last fall, the state Department of Health distributed specific crisis standards, which included how patients should be triaged and prioritized for care should a hospital need to ration its intensive care unit beds. This guidance was distributed statewide, in an effort to make access to care and treatment more fair.

The idea is that regardless of what hospital you arrive at, care will be triaged and delivered the same during a state-declared crisis.

“It’s equal and fair, and that’s the principle behind crisis standards is you want to be fair to everybody,” Richards said.

Currently, many hospitals are dealing with staff shortages. This means that it’s harder and takes longer for staff to deliver the same quality of care they would during normal times. Staff are stretched thin, seeing more patients than they normally would. The constant triaging and prioritizing patients and making sure the person who needs the resource the most gets it all takes more time.

“It’s harder for us, and logistically, it takes more time to make it happen,” Richards said.

The hope for the next few weeks of the omicron wave is to buoy hospitals at current levels . Non-clinical National Guard members will come to Sacred Heart Medical Center this week to assume some of the work of clinical care staff in the emergency room. If you need to visit the emergency room for a true emergency, you will get care, but if you need things like COVID testing, it’s best to seek that service elsewhere.

The state hit record-high COVID hospitalizations as of last Thursday. There were 2,135 patients hospitalized with the virus. COVID hospitalizations are increasing in Spokane County, and at one point last week, local ICUs were at 100% occupancy.

Inslee sent National Guard staff to several hospitals, and contracted staff are being deployed to long-term care facilities .

“The goal is to hope that those (measures) work and continue to help us combat any sort of progression towards crisis,” Richards said.

It’s a tough time to be a health care worker, and the next few weeks are going to be challenging.

If he had one request to the community, Richards said, it would be to “be patient and be kind.”

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories 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.