SEATTLE — Gov. Jay Inslee announced Thursday he is deploying the Washington National Guard and putting a pause on non-urgent medical procedures to help alleviate the strain on hospitals, many of which are at or over their capacity to treat patients.
Washington's health care system was overburdened before the omicron surge, and COVID-19 hospitalizations have increased by 75% in recent weeks. The state currently has over 2,000 hospitalizations across the state. COVID-19 patients make up 18% of all hospitalizations and 22% of patients in the ICU. Of COVID patients, 80% are unvaccinated, according to state data.
"Unfortunately, those numbers are going to continue to climb," Inslee said.
Hospitals are using crisis staffing models to make sure patients who need care receive it, industry leaders say.
Hospital leaders have repeatedly called on the governor to address the capacity and staffing crises in hospitals.
In light of capacity concerns, Inslee ordered hospitals to temporarily halt non-urgent procedures for the next four weeks so staff can be dedicated to "emergent patients" at hospitals.
The National Guard will be deployed to help with "non-medical tasks" at Providence Regional Medical Center in Everett, Yakima Valley Memorial Hospital in Yakima, Confluence Health/Central Washington Hospital in Wenatchee and Providence Sacred Heart Medical Center & Children's Hospital in Spokane.
The National Guard will also be deployed to help fulfill the demand for COVID-19 testing at Providence St. Peter Hospital in Olympia, Kadlec Regional Medical Center in Richland, UW Medicine/Harborview Medical Center in Seattle and MultiCare Tacoma General Hospital in Tacoma.
Two FEMA testing sites are being set up in King County and Snohomish County.
Inslee encouraged hospitals to take advantage of a federal contract making clinical and non-clinical staff available to Washington hospitals. Washington State Secretary of Health Dr. Umair Shah said over 875 personnel have already been deployed to hospitals and another 200 are in the process of being deployed. Roughly another 125 personnel are available to hospitals but haven't been requested yet.
Inslee also put out a plea for retired medical workers to return to the workforce temporarily to help fill in the gaps in the midst of the staffing crisis. Anyone who is qualified can sign up at WAServ.org to help with testing, vaccinating and working in hospitals or other locations.
In the hopes of addressing the health care workforce shortage into the future, Inslee is also dedicating $30 million to help nurses, nursing assistants and medical assistants fulfill educational and clinical requirements. The governor will also work to increase professional development opportunities for health care workers to keep them in the workforce.
Discharging patients to long-term care facilities
The state is also taking steps to make it easier to discharge patients to long-term care facilities, which hospital leaders say is making it difficult to create space for other patients.
Inslee plans to dedicate expansion staff to provide care in nursing homes in order to increase their capacity and allow them to admit patients who no longer need acute care. More resources will be dedicated to expediting guardianship proceedings, which can also leave many patients stuck in the hospital.
Hospital leaders have asked Inslee for an executive order allowing hospitals to bypass the guardianship requirement to move some patients into long-term care facilities, however, the governor said on Thursday he does not have the executive authority to do that.
"What they've actually asked me to do is ignore the law," Inslee said. "They've actually asked me to just basically say 'don't enforce it.' I can't do that."
The state is also contracting with Area Agencies on Aging (AAA) and deploying additional staff to help patients transition out of the hospital and into nursing facilities.
Extra staff will perform assessments, work with patients on transition planning and selecting qualified providers.
AAA will perform care transitions at high volume hospitals to free up hospital discharge planner time and assist individuals transitioning from the hospital in accessing community resources, reducing readmissions and creating more capacity for short-term post-hospital stays, according to the state.
Hospitals using "crisis staffing models"
The state’s health care system is experiencing the “worst situation” it has seen since the start of the COVID-19 pandemic, according to Taya Briley, executive vice president for the Washington State Hospital Association (WSHA).
“We are experiencing a crisis across our medical system,” Briley said during a Thursday WSHA briefing, adding that hospitals are resorting to crisis staffing models to ensure patients who need care can get it amid the latest omicron surge.
These crisis staffing models, Briley explained, are concerned with “balancing the need to actually get care to the bedside with the fact that we need to be as safe as we possibly can in delivering that care.”
Briley said the models are under the guidance of the Washington State Department of Health and the Centers for Disease Control and Prevention and pertain to how quickly hospital staff can return to work after testing positive for COVID-19 and which patients they can care for.
“They are assigned to work in areas with patients that will be in as safe as an environment given the staff member has returned to work from having had a COVID case,” Briley said. “So, that means that if somebody who has had COVID is back at work, the first place that they will be working is with patients who have tested COVID positive.”
MultiCare Health Systems hospitals say with the surge in Omicron and the increase in the need for their services, some of their hospitals are operating at more than 100 percent capacity and they need staff. MultiCare has a return to work policy for staff who test positive for COVID-19.
In an email, Holly Harvey with Corporate Communications for MultiCare Health Systems wrote, “the health of our employees remains a top priority and if they do not feel well enough to return to work we want them to remain at home. Return to work will vary by employee and is predicated on factors such as symptoms and severity of illness. Regardless of the underlying cause of the illness, employees who are sick must remain at home until they are fever-free for at least 24 hours without using medication, their symptoms are getting better and they are feeling well enough to work. Some COVID-19 positive employees are able to come back to work. However, we have implemented rigorous protocols based on guidelines by the CDC and WSDOH to enable us to treat all patients safely.”
Continued issues with difficult to discharge patients, an influx of patients coming into emergency departments seeking COVID-19 tests and hospital staff testing positive for the virus have put hospitals in an ever-tightening bind.
WSHA has previously requested three specific actions from the state to address the bottleneck of patients in hospitals before Inslee's announcement Thursday.
First, WSHA asked the state to send more staff to help speed up the process to evaluate and assist patients who need to be discharged to a post-hospital facility. Briley said this process can take weeks to months. Hospitals also asked the state to remove its guardianship requirement for the discharge of patients unable to make their own medical decisions.
Currently, the state is expediting guardianship proceedings and contracting with area agencies to perform care transitions for those not relying on Medicaid.
WSHA also asked that the state help alleviate staffing shortages in non-clinical settings by using personnel from the National Guard or a contracting agency.
National Guard members will be deployed to eight Washington hospitals to assist with "non-medical tasks" and COVID-19 testing.
“We need these things to happen now and we are asking for swift action. This is not a time for deliberating,” Briley said.
Hospitals also ask those looking for tests or not seriously ill to avoid going to the emergency room.
Chief Medical Officer Dr. Michael Anderson with Virginia Mason Franciscan Health said his facility has seen a “1,000% increase in the number of individuals showing up in the emergency department.”
While Briley said that a formal crisis standards of care declaration is not imminent in the state, she said weekly COVID-19 hospitalizations for the state are at an average of 1,800, which is more than the previous high of 1,700 set in September last year.