Harborview Medical Center will temporarily stop accepting less-acute patients and instead divert them to other health care systems in the area — reflecting a “very difficult decision” as capacity challenges worsen, the hospital’s CEO announced Thursday afternoon.
“All hospital systems [are] very much over capacity with very high census numbers, particularly because of an inability to discharge patients into post-acute care settings,” said Harborview CEO Sommer Kleweno Walley. “This morning … Harborview reached an unprecedented census level.”
Harborview is currently caring for more than 560 inpatients, more than 130% of its licensed capacity of 413 patients. About 100 are “medically stable” patients who no longer need hospitalization and are waiting to be discharged to a long-term care facility, like an adult family home, Kleweno Walley said.
“We’ve reached a level at this point where we do not feel it’s appropriate or safe to take in any more patients that don’t require the unique, very skilled expertise of providers and staff that we have in-house,” she said.
The plan to accept only critically ill patients for the time being, known as “advanced life support,” includes triaging and diverting ambulances with less-acute patients to other area hospitals, as long as Harborview continues to battle unsustainably high patient loads. It will likely be in place through the weekend if not longer, she added.
Those less-acute patients, for example, might include people who have early signs of appendicitis or who are experiencing trouble breathing — but who can be safely cared for without Harborview’s critical care resources, said Dr. Steve Mitchell, the hospital’s acting medical director.
Harborview will still accept walk-in patients to the emergency room, hospital spokesperson Susan Gregg said.
In order to again accept all types of patients, the hospital will not only track “sheer numbers,” but also look at its number of ICU patients and other factors that reflect the hospital’s ability to offer critical care, Kleweno Walley said.
“It will really depend on when we feel like we can safely take on patients that are not just trauma or critical illness,” she said. “We’re really doing this at this point to preserve our ability to be the Level I trauma center and ensure all trauma and critical illness have a place to go.”
Harborview is the only Level 1 trauma center in the state. The hospital’s trauma care won’t be affected, and it will continue to take patients in acute or life-threatening condition.
Swedish’s First Hill and Cherry Hill campuses and Virginia Mason Franciscan Health, near Harborview on Seattle’s First Hill, have agreed to take additional less-acute patients, Kleweno Walley said. While those systems “do have the capacity to surge a little bit and take patients,” no hospitals have a huge excess of space and staffers, she said.
In addition to issues around discharging stable patients, delayed care and staffing shortages are also limiting available beds, Mitchell said. King County’s growing and aging population has also meant a larger burden on the region’s health care systems, Mitchell said.
The last time Harborview made this move was in September 2019, when it had similar problems discharging stable patients.
“The difference now is that in the past, when Harborview had census problems because of this difficult-to-discharge [issue], other hospitals had more capacity,” Kleweno Walley said.
Harborview isn’t alone in straining for more bed space and staffers, and the issues are also affecting hospital finances. Many of Washington’s hospitals have been facing massive financial losses in recent months, which several health care leaders largely attributed to an increasing number of high-cost patients staying in hospitals for long periods of time.
According to a survey conducted by the Washington State Hospital Association earlier this year, hospitals across the state suffered a net loss of about $929 million in the first three months of 2022.
The recent losses are also due in part to high inflation and labor shortages — which have resulted in labor, drug and supply costs increasing faster than payment rates, said Eric Lewis, WSHA’s chief financial officer.
In July, Gov. Jay Inslee’s office said in a letter to WSHA leaders the state would continue to work on longer-term solutions to the staffing crisis.
In the meantime, however, the state promised to extend statewide rapid-response teams to long-term care facilities through March 2023; provide incentives for long-term care facilities to take hospital patients; and partner with Harborview in adding more beds, among other support.
While WSHA leaders have said the steps have helped, more support is needed statewide.
“This is definitely the most challenging time of the pandemic,” Kleweno Walley said.