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Comment: Our hospitals are near breaking point and need help

The pandemic, delayed care and staffing shortages threaten the facilities that are core to health care.

By Darren Redick, Lisa LaPlante, Brian Ivie and Elise Cutter / For The Herald

As leaders of hospitals north of King County, we want to share with the public how national health care challenges are affecting us in the region.

Our communities rely on us for care and throughout the pandemic our staff have been on the front lines. We have weathered new and frightening variants, surges of COVID-19 patients, supply chain disruptions and much more. Now, however, we are faced with a different kind of crisis that is affecting our ability to care for patients.

As people return to the hospital to seek care that has been delayed for up to two years, we are seeing patients with more advanced disease, worse symptoms and grimmer prognoses. We are also seeing the impact of crises in our communities, particularly an influx of behavioral health patients and patients seeking treatment for fentanyl and other substance use disorders. Our hospitals are busier than they have ever been, operating above capacity, while our workers are exhausted.  

Many health care workers who endured the pandemic are now leaving the industry, either temporarily or permanently. The national talent pipeline is not sufficient to meet the need. Wage adjustments have allowed us to attract, hire and retain health care workers to an extent, but hospitals in Washington state still have thousands of open nursing positions. Hospitals are also experiencing a financial crisis after two years of reduced surgeries, delayed care, high labor costs and supply chain disruptions. We are not alone; health systems nationally have seen labor expenses jump 19 percent and supply costs jump 20 percent over the last two and a half years.

While our staff work tirelessly to care for the hundreds of new patients who come through our doors every day, our hospitals are housing hundreds of patients who are medically ready for discharge. Unfortunately, many do not have a place to be discharged to, so they remain in the hospital and require staff, beds and resources that could be used for patients with critical immediate needs who are waiting in our Emergency Departments to be admitted. Some hospitals continue to postpone many non-urgent, but medically necessary, surgeries and procedures because of staffing and bed capacity constraints. Over time, these delays cause harm to patients and families in our communities.

We need help. Hospitals are critical community infrastructure. We need our local leaders and elected officials to devote resources to post-acute care facilities in our communities, including skilled nursing facilities, respite shelters, behavioral health facilities, and more. Hospitals are meant to care for people who need immediate medical care, not as substitutes for long-term care.

We need state legislators to reform current regulatory processes that create unnecessary barriers to timely discharge. Changes in interpretation of guardianship regulations have exacerbated discharge delays. In addition, staffing is historically low at Washington’s Home and Community Services Division, which must assess patients who may be eligible for Medicaid funding before discharge to long-term care facilities, further lengthening inpatient hospital stays. We also need policy solutions to graduate more nursing staff who will stay and practice in Washington.

These are complex issues and there are no easy answers, but action is imperative. Our current situation is unsustainable. Hospitals across the nation and Washington state — including some of our hospitals in Snohomish, Island and Skagit counties — have been forced to close beds, pause admissions to units, or divert ambulances from our Emergency Departments because we do not have enough staff to safely care for patients.

Our hospitals are an essential part of our communities. We are asking for help. Our hope is that by raising awareness of these issues, our elected leaders can come together and find solutions to ensure your community’s hospital is here to care for you and your family when you need us, always.

Elise Cutter is chief executive officer for Island Health. Brian Ivie is president and chief executive officer for Skagit Regional Health. Lisa LaPlante is chief administrative officer for EvergreenHealth Monroe. Darren Redick is chief executive for Providence Regional Medical Center Everett, Swedish Edmonds and Swedish Mill Creek Emergency Department.

This op-ed was published by The Heraldon July 17, 2022.