Emergency rooms, like the one at Oregon Health & Science University, end up boarding mental health patients who have no where else to go. (Christine Torres Hicks/OHSU)
People in Oregon are dying as a result of the state’s hospital staffing shortage.
Patrick Allen, director of the Oregon Health Authority, told a state legislative committee on Thursday that people in need of intensive care often have to wait for admission because hospitals lack staff. And that, he said, can lead to the worst consequences.
“They would have had a good outcome, but in at least a few cases people died waiting for that higher level of care,” Allen told the Interim Senate Committee on Health Care during an informational hearing. “It truly is as great a crisis as we’ve had throughout the pandemic.”
With some patients waiting for admission, others can’t get out. At any one time, about 700 people are either languishing in hospitals awaiting discharge because facilities offering a lower level of care lack staff or they’re stuck in emergency rooms, awaiting a hospital bed, Allen said.
His testimony came a day before the legislative Emergency Board is due to consider a $40 million request from the health authority and the state Department of Human Services for hospitals that coordinate care in Oregon’s six hospital regions, clinical staff to coordinate patient transfers and money to hire 50 more contract nurses.
Hospital specialists say these proposals will only provide short-term relief and only help certain sectors. The staffing crisis is widespread, affecting medical and mental health care facilities alike, including Unity Center for Behavioral Health in Portland, the only licensed psychiatric care facility in Oregon open 24 hours a day. Melissa Eckstein, Unity’s president, said the facility ends up keeping patients longer than necessary because they, too, have nowhere to go.
“It’s not uncommon for us to have patients that are here in excess of six months because we simply don’t have a way of moving them out of hospital,” Eckstein said.
The state lacks residential care beds and wait times for outpatient care are too long, Eckstein said. Research shows patients need to receive outpatient care within a few days of leaving the hospital to have a chance at improving, but wait times in Oregon can be as long as three months, she said.
Administrators say hospitals, clinics and long-term care facilities lack thousands of staff, from primary care physicians and physician assistants to nurses and medical assistants. As a consequence, hospitals have had to turn people away, while others show up in emergency rooms and leave because waits are so long.
Frank Ehrmantraut, who oversees paramedics and emergency medical services at the Polk County Fire Department, told the committee that it should only take 20 minutes to register and admit a patient once an ambulance arrives at a hospital, but sometimes his staff have to wait with the patient for a bed.
“They may sit in that hospital hallway on our gurney, being cared for by our paramedics, for up to two hours sometimes,” Ehrmantraut said.
Sometimes even the hospital hallways are full.
“In one case, the hospital was so full that there was physically no room for EMTs and paramedics to stand with the gurney in the hallway,” Ehrmantraut said. “The patient had to stay in our ambulance in the parking lot of the ambulance bay for an hour and a half to get a 20-minute procedure.”
The causes of the staffing shortage are multifold, said Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems. Oregon has the lowest number of hospital beds per capita in the country, she said. Over the last two and a half years, many baby boomers retired, stress and burnout pushed nurses and other professionals away from health care and the industry was hit, like others, with the “great resignation” during the pandemic.
On top of that, hospitals have lost money. Revenues are flat but expenses like staff and pharmaceutical costs keep going up, Hultberg said.
“That is not sustainable and calls into question the long-term viability of our community hospitals,” Hultberg told the committee.
The crisis has had a direct impact on patients, with longer wait times, shared occupancy rooms and delayed care, said Cheryl Wolfe, a registered nurse and president and CEO of Salem Health.
Salem Health has the busiest emergency department in Oregon and Washington, with more than 100,000 ER visits a year, Wolfe said.
“Salem Health has been over 100% capacity nearly every day for the last two years,” Wolfe said.
It hired 330 contract professionals, who cost much more than staff, but even that hasn’t been enough to meet the demand, Wolfe said. This summer, the hospital decided to close its doors to ambulances with patients who are not in critical condition for the first time since 2008.
“We have seen a small reduction in the volume of patients after we implemented a divert policy, but we continue to see high volumes as we get ready for our busiest months,” Wolfe said.
Health care professionals are bracing for fall and winter, when respiratory infections typically spike as people gather indoors. And though Covid infections have fallen, new variants could surge, Allen said, at a time when many people have ditched their masks.
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