Hospitals in Thurston and Lewis counties have taken steps to avoid diverting patients from their emergency departments due to overcrowding.
The hospitals worked with their emergency medical service partners to pilot a policy change from March 2 to June 2, said Ben Miller-Todd, the interim assistant director of emergency services for Thurston County.
Miller-Todd told the Thurston County Board of Commissioners of the policy change during a meeting last Tuesday. He said the changes should make emergency departments more efficient and patients should less often be told that they can't be taken to their hospital of choice.
"Hospitals will continue to take patients even during times of high volume and high census," Miller-Todd said. "Hospitals should not be refusing patients unless there are concerns regarding hospital capabilities to treat a patient."
He said MultiCare Capital Medical Center, Providence St. Peter Hospital and Providence Centralia Hospital informally agreed to the new policy with Lewis and Thurston medical program directors and Thurston County Emergency Medical Service partners.
"I will say that all three hospitals and EMS partners have been doing a wonderful job of following this," he said. "And I can say that our facilities have only gone on divert three times for a very brief period of time over that 90-day, now (nearly) 120-day period."
Any one hospital going "on divert" would often cause other hospitals to overcrowd and begin turning away patients themselves, according to Providence Southwest spokesperson Chris Thomas. The new agreement helps keep that from happening.
"We are pleased with this arrangement and improved process," Thomas said. "Our community emergency management teams are able to better manage patient flow into the hospital, and emergency department teams are better able to manage throughput."
In a statement, Bill Kriegsman, Chief Medical Officer at Capital Medical Center, said the trial was very successful and led to some unexpected benefits.
For one, the changes reduced stress and transportation times for EMS crews because they could select their own destination hospitals. They also reduced the workload of a nurse at St. Peter Hospital who was responsible for assigning destinations to EMS crews during divert status.
"Because of the success of this trial we have decided to continue it indefinitely," Kriegsman said. "We are very happy with this work, particularly because it improves patient experiences and supports the important work of our EMS partners."
The changes
Miller-Todd said the previous policy allowed for hospitals to go "on divert" for several reasons that are still applicable, such as power outages, lacking services, equipment failures and safety.
The new policy calls for hospitals to avoid citing overcrowding as a reason to turn away patients. He said the ability of hospitals to on divert status was controversial because it effectively took hospitals offline, creating backflow issues, lengthier turnaround times and high patient loads at other facilities.
"This really doesn't reduce the number of residents in Thurston County or region that are seeking emergency care," Miller-Todd said. "So ultimately, the volume of patients that are calling 911 doesn't suddenly get reduced at the point that a hospital decides to go on divert for overcrowding. They have to go somewhere."
To be clear, he said federal law prohibits emergency departments from refusing to stabilize and treat patients that arrive at their facility. So, diversions would take place while patients were being transported by EMS.
Miller-Todd described the previous policy as a "round robin" style of hospital diversion whereby each hospital would share the patient load to avoid sending them out of the region. This cumbersome process was hard for EMS to track, he said.
"It was a drain on hospital resources due to the administrative overhead that it required to manage the round robin process," Miller-Todd said. "And patients were routinely informed the hospitals were on divert and they were ultimately struggling to get them into the hospitals they preferred."
Patients always have a right to determine their destination, but he said they should be informed of emergency department turnaround times when making their choice.
He said EMS will generally prioritize the most appropriate facility over the closest facility depending on patient needs. Otherwise, the closest facility will be chosen.
In some instances, patients would be diverted into Pierce or Lewis counties, he said. Ideally, he said EMS partners should avoid this.
"When we remove patients from their communities, it makes it much harder for family members to travel to those patients and ultimately for that patient to seek follow-up care with those facilities that they were transported to," Miller-Todd said.
Miller-Todd said the county's Emergency Service information technology team has created a hospital turnaround dashboard that allows EMS to inform patients of wait times. He said they have been tracking and communicating staffing and turnaround times for each of their EMS partners.
This approach has garnered interest from regional partners and Washington state officials, he added.
Why are hospitals overcrowded?
During the Tuesday presentation, Thurston County Commissioner Gary Edwards questioned why hospitals have been overcrowded.
Miller-Todd listed several reasons. He said the county's population has been growing and aging. This has led to a growing patient population that has strained the hospital system "from the EMS volume perspective and the infrastructure perspective."
"We have had limited infrastructure growth to support the population growth," he said.
Additionally, he said the county has a fairly high hospital census due to fluctuating numbers of patients admitted with COVID-19.
"That's been trending down overall, but we saw a slight bump over the last few weeks has been reported by (Thurston County Public Health and Social Services)," he said. "That takes up a little bit of bed space."
Lastly, interim PHSS director Kurt Hardin said staffing has been an ongoing issue for the area's long-term care facilities, which is where many hospital patients are sent when they are discharged from the hospital.
"You can't free up a bed inside the hospital if there's no place for the patient to go," Hardin said. "A lot of long-term care facilities do not have the capacity due to either staffing shortages or because of COVID to be able to accept that patient back after they've been sent to the hospital."
Thomas at Providence Southwest pointed to the staffing issues and the pandemic to explain overcrowding. He said Providence emergency departments often were running at near 100% capacity even before the COVID-19 pandemic.
"Our community continues to grow," he said. "The COVID-19 pandemic and people delaying general and preventative care has led to sicker patients they present to the hospital, causing patients to need a higher level of care and longer stays at the hospital."
Some relief is on the way. MultiCare Health System is moving forward with a new off-campus emergency department in Lacey, The Olympian previously reported. The Tacoma-based health care system plans to build a 10-bed, 10,000-square-foot emergency department at Golf Club Road Southeast at Pacific Avenue.
The new facility is expected to open in June 2023.
