OHSU hosted a roundtable discussion Wednesday, March 12, to raise public awareness of Oregon’s hospital capacity crisis. (OHSU/Christine Torres Hicks)
Hospitals around the state continue to operate at extremely high capacity due to ongoing health care workforce challenges, rising costs of supplies and wages, and patients coming in with more complex needs due to delayed care, panelists said during a roundtable discussion at Oregon Health & Science University.
The status quo — 100%-plus capacity at OHSU Hospital and 85%-plus statewide — is not only unsustainable but also is significantly impacting the health and well-being of people in Oregon.
OHSU hosted a roundtable discussion Wednesday, March. 12, to discuss in detail the severity of Oregon’s hospital capacity crisis, how capacity affects health care access and quality of care, and both the short- and long-term solutions being explored by OHSU and hospitals around the state.
“I’m honored to be here today to discuss challenging and complex issue of capacity management and access to care for Oregonians,” said moderator Stephanie Gilliam, M.N., RN, director of Mission Control at OHSU. “It’s imperative that we take steps to ensure we’re available to provide timely care for all 4.3 million Oregonians who might find themselves or their family members in need of the care we uniquely provide. Access to timely, high-quality health care should not be a privilege — it’s a necessity.”
Panelists explained that on top of the strain from the coronavirus pandemic, Oregon has among the lowest ratio of beds per capital in the country. This reality for patients means the care they receive will look different: They could be receiving care in a hallway or overflow space, or they could be waiting hours or days to be seen.
“We’re seeing more patients than ever before,” said Mary Tanski, M.D., chair of OHSU’s Department of Emergency Medicine. “More patients are seeking care in emergency departments. They’re sicker, more complex and they have more needs, so their visit takes longer. When all the hospital beds are full, they don’t have access to a room, so they stay waiting in the ED beds.”
Claudia Aime, D.N.P., RN, chief nursing officer at OHSU overseeing the adult inpatient and emergency departments, shared how these issues have affected morale and working conditions for nurses and other health care staff.
“As health care workers, we have to continue advocating for better working conditions for our nurses and other health care staff,” she said. “Their health, their morale and their ability to do their job depend on it. Ultimately, improving these conditions will improve the care that we can provide.”
A pediatric critical care physician at OHSU Doernbecher Children’s Hospital echoed these concerns and explained how the issue uniquely impacts Oregon’s most vulnerable patients — children.
“This has very real implications for families and patients that we’re taking care of,” said Carl Eriksson, M.D. “Within the past couple of years, there was a young child with leukemia who needed our inpatient services and had to spend the night in an emergency department in a relatively small hospital while waiting to come into Doernbecher. That’s obviously a really stressful situation for the patient, the family and for all the people trying to provide care for that child.”
Panelists emphasized that the issue isn’t isolated to OHSU or the Portland-metro area, but also has statewide impacts for all Oregonians seeking health care.
“The ideal arrangement for acute care is that community hospitals can care for their patients to the extent of their abilities and resources, and then when a patient requires skills that are not available, those patients would be moved to a higher level of care. That’s the idea the system was built around,” said Steve Vets, D.O., chief medical officer at Santiam Hospital in Stayton, Oregon.
“However, we experience challenges with staffing and bed capacity — not only us but all hospitals around Oregon — and are forced to transfer patients that ideally, we’d like to keep in their community.”
Panelists highlighted both short- and long-term strategies to address capacity issues, including focusing on better coordination of inpatient patient volumes statewide, construction of new inpatient bed spaces, and opportunities for health systems integration.
Learn more: OHSU Hospital Expansion Project
“All the hospitals came together to serve Oregonians and created the Oregon Medical Coordination Center, a real-time bed tracking tool. At the moment, the center facilitates 30 to 50 activations a week,” said Matthias Merkel, M.D., Ph.D., OHSU’s senior associate chief medical officer for capacity management and patient flow. “I’m pleased that the new inpatient addition will open next year and add 128 beds. It will add 10 to 12 daily admissions — a huge benefit, but not even close to the 2,500 beds we’d need to get to the average other states have.”
A critical effort is strengthening the health system overall, including creating more opportunities for preventive care that hopefully keeps patients from getting to the point of hospitalization. Atif Zaman, M.D., senior associate dean in the OHSU School of Medicine and chief clinical officer of OHSU Health, explained how OHSU’s planned integration with Legacy Health could support this goal.
“I don’t think the only solution to our capacity problem is having more beds and managing those beds, it’s also about preventing hospitalization, including preventive and primary care,” he said.
“I am very excited about this opportunity we have with the integration of OHSU and Legacy. To be able to offer patients that full continuum of care will be an exciting opportunity for Oregonians. There is an advantage to having a single system, because it can accelerate access and patient care coordination.”
Gilliam wrapped up the discussion by highlighting hospitals’ commitment to providing high-level care for people throughout the Pacific Northwest and emphasized the need for statewide collaboration to change the status quo.
“Together,” she said, “we can ensure that every Oregonian, from our youngest to our most vulnerable, receives the timely and compassionate care they deserve.”