Hospitals in Washington state are preparing for a flood of coronavirus patients, demonstrating heightened concern as infections climb, a higher proportion of tests return positive and more people are admitted to the hospital for COVID-19.

“Hospitals are implementing their surge plans, making plans to start canceling some procedures, calling in extra staff and trying to get extra staff, which is challenging,” said Cassie Sauer, chief executive of the Washington State Hospital Association. Some hospitals have limited visitation.

The surge response, at least initially, will look different from last spring, when Gov. Jay Inslee halted all elective procedures.

Rather than widespread cancellations, UW Medicine told staffers it planned to triage elective surgeries and procedures and balance the use of telemedicine with in-person visits.

“ … We are working to maintain access to essential care,” wrote Lisa Brandenburg, president of UW Medicine Hospitals & Clinics, and Tim Dellit, chief medical officer at UW Medicine, in a message Thursday to the system’s staffers.

UW Medicine plans to gradually dial back elective care as more beds or staff become needed for COVID-19 patients. Members of the organization’s emergency operations center will meet daily and discuss bed capacity, staffing and supplies.

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UW Medicine on Monday was caring for 56 COVID-19 patients — double the number recorded a week before.

Sauer said some hospitals are taking a harder look at admitting patients for surgeries that require space in intensive-care units or that require lengthy inpatient stays for recovery.

As cases rise, so do concerns about the spread of COVID-19 from community members. All CHI Franciscan acute-care hospitals this week restricted visitors except in certain circumstances, like end-of-life care or births.

Mary Shepler, chief nursing officer at EvergreenHealth in Kirkland, said the hospital system had not made any policy changes as case loads climb, but she said administrators were watching with “heightened” attention any shifts to COVID-19 data and considering their options.

“We’re in that active conversation now, whether we need to roll back visitor policies,” Shepler said.

Shepler said administrators check the number of COVID-19 patients at Evergreen and the supplies on hand every eight to 12 hours.

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Sauer said the need for personal protective equipment is not nearly as dire as it was last Spring.

Many hospitals have expanded their ability to provide intensive-care units and negative pressure rooms, if they are needed, Sauer said. Shepler said Evergreen had 100 rooms with negative pressure available, with 52 in use and another 48 available with the flip of a switch.

Instead, hospitals are primarily worried about having enough staff with critical-care training to respond to a surge, particularly when many workers are exhausted and frustrated after months of dealing with COVID-19.

At Evergreen, Shepler said staffing remained stable for now, but the hospital system does hope to bring in more traveling nurses.

“There’s a shortage of nursing, which we all knew, which has become worse during the pandemic,” Shepler said.

Shepler said the price to hire traveling nurses had risen by more than 50% since before the pandemic.

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“We’re, all across the nation, looking at the same pool of people,” Shepler said. “Supply and demand.”

Both Shepler and Sauer said they were concerned about the Thanksgiving holiday.

“The behavior people do right now is going to determine who lives and dies this winter,” Sauer said.