Harborview Medical Center continues to care for nearly 100 more inpatients than its licensed capacity as it struggles to discharge patients who no longer need hospitalization but still need significant care and have nowhere to go, the hospital’s CEO said Wednesday.
Harborview, which is publicly owned and serves as the trauma center for much of the Northwest, is licensed for 413 inpatient beds.
It currently has about 500 inpatients, CEO Sommer Kleweno Walley told King County’s Regional Policy Committee, comprising city and county government officials.
The hospital averaged about 477 inpatients, well above its licensed capacity, through fiscal year 2022, which ended in July.
The capacity crisis peaked a month ago when the hospital had 562 inpatients and had to divert less-acute patients to other area hospitals.
Harborview also serves as the disaster preparedness hospital for Seattle and King County and serves difficult-to-treat populations, including people in King County jails and those with mental illness and addiction.
“We had literally no further place to board patients,” Kleweno Walley said. “The next car wreck that needed to come in, we could not care for at that point.”
The “basic life support divert” in effect for about a week in August resulted in about 10 fewer patients per day arriving at Harborview, even as the hospital continued to accept the most critically ill patients.
The primary issue facing Harborview, as well as other hospitals in the region, is not that there are too many patients coming in; it’s that it’s difficult to impossible to discharge patients when they’re ready to leave.
When Harborview had those 562 patients in August, 152 of them did not need to be there, Kleweno Walley said.
They needed to be in a long-term care or skilled nursing facility, like an adult family home, with help dressing, eating and bathing, but without the acute medical services that a hospital provides.
About half of the state’s nursing homes report being short-staffed, according to the Centers for Medicare & Medicaid Services, about three times more than the number reporting low staffing levels near the start of the COVID pandemic.
“We have individuals who need to move to the next level of care, but there is no level of care to move them to,” Kleweno Walley said.
An additional 94 patients were in long-term care facilities with funding from Harborview, a program the hospital launched in 2018.
While Harborview used the diversion program only for about a week in August, as an emergency stabilization measure, it had a spillover effect on other health care providers.
Ambulance services have to travel longer distances to take patients to other hospitals, or have to wait with patients that can’t be immediately admitted. Other hospitals, of course, have to take patients that otherwise would be at Harborview.
Harborview continues to “treat and transfer” patients to other area hospitals, especially those also within the UW Medicine system, Kleweno Walley said.
Last year, Harborview had an average of 85 patients who didn’t need to be hospitalized but couldn’t be discharged because there was no facility to take them. That’s a number that has been stubbornly high for years.
Solutions tend to involve more funding. The state is providing some emergency staffing to long-term care facilities. Harborview has asked the state for help in reducing its difficult-to-discharge patient population to 50. And the hospital is asking local, state and federal officials for funding to help expand long-term care options.
The crisis in discharging patients is not unique to Harborview. Many of the state’s hospitals are near or over capacity, according to industry officials.
The Washington State Hospital Association earlier this summer said many facilities, especially in the Puget Sound region, are at 120% to 130% of their capacity.
At Swedish Health Services, about 17% of patients no longer require hospital care, chief nursing officer Kristy Carrington said in July. At MultiCare Health System, based in Tacoma, staffers were caring for 180 patients who could be discharged.
“In many ways, Harborview is the canary in the coal mine,” said King County Councilmember Pete von Reichbauer, chair of the Regional Policy Committee. “What happens at Harborview is happening throughout our region.”
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