When hospitals are overwhelmed and run out of options, they all call the same number

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Rural Washington state hospitals have been slammed with Covid patients, most of them unvaccinated.

Before the last wave, many health facilities were already at full capacity. The influx of patients driven by the delta variant has taken things up a notch, which means patients of all kinds are struggling to find a bed.

In recent months, this has led to hundreds of patients being moved around the state in order to receive care and prevent facilities from reaching crisis levels like those seen in other places.

The Washington Medical Coordination Center (WMCC) – run by a small team at Seattle’s Harborview Medical Center – is the agency that helps move patients.

Normally, when a hospital has a patient it cannot take care of, it takes care of it itself. They call their network and find an open bed.

The problem with hospitals these days is that the places they normally rely on are also full.

When hospitals run out of options, they all call the same number for WMCC.

“If they call us, it’s because this system has failed,” said Mark Taylor, director of operations at the coordination center.

Taylor said the pandemic is not affecting all areas equally.

“The only strategy we have to face is to balance that, to spread that impact across the entire continuum of health care.”

This means Washington residents can still get the care they need and hospitals are avoiding crisis levels.

But mixing patients up has certain drawbacks as well. People can find themselves hours away from their families and communities, and small communities can find themselves with exhausted ambulance services for long periods of time while the patient is driven to another part of the state.

“But the bottom line is that while we try to keep the patient as close to their community as possible, we have to find a place that can support them safely,” Taylor said.

Every week, patients are transferred from the eastern part of the state to the Puget Sound area.

Almost all of the calls the coordination center receives are from small rural hospitals, according to its staff. And the number of transfers has exploded in recent months.

From November of last year to the end of June, WMCC received 285 calls for help.

Then delta hit. From July to mid-October, they received 1,313 patient transfer requests.

“This is a real sign of the incredible extent of our health care system in our state when the safety net has to be used so many times,” said Dr Steve Mitchell, WMCC Medical Director.

And the phone just keeps ringing.

On a recent Wednesday, Maria Paulsen is the person who takes care of the telephone line. Paulsen is the director of program operations for the coordination center.

When the calls come in, she gets details about the patient’s condition, where they are, what they’ll need, what facilities the hospital has already called looking for a bed, and then she does that research in. statewide.

When Paulsen calls to ask to transfer a patient to a hospital, she can get three main responses; yes, no, or the patient is put on a waiting list.

If there is an emergency and everything is full, Paulsen has the latitude to pull some strings. Unlike any individual hospital, the WMCC team has agreements with hospitals across the state that in certain situations can order a facility to take a patient, and that institution simply has to operate it. It is not a card that they play unless they have to.

The day I meet Paulsen, she goes out on a night shift with the phone. She works in a conference room at Harborview Medical Center, although sometimes she works in a closet in her home.

Screens in front of her show hospital capacity across the state.

There are a lot of zeros.

“It tells me there is no availability in our state,” Paulsen said.

Every 20 minutes or so, his train of thought is interrupted by the loud, ringing sound of his ringtone. Her kids hate it, and it drives her husband crazy, she said.

But it’s strong, and it catches his attention, so it stays.

“WMCC, this is Maria. “

It’s a phrase Paulsen repeated over and over again. Over the summer, call volumes to the small WMCC team exploded.

They would receive 20 to 30 calls over a 24 hour period. He took over.

Paulsen answered calls at the grocery store. Her coworkers had to pass chores to each other just so they had enough time to get home without having to stop to answer a call.

All the while, the team was juggling their daily chores at the hospital.

It was, as Paulsen describes it, “soul sucking,” and it took a toll on their personal lives.

Paulsen said she and her husband couldn’t watch a TV show or movie without him being interrupted. When she is at night, she sleeps in another room so that the phone does not wake her partner. It is devouring.

Mitchell sees it in his 11-year-old son’s response when asked why people should get vaccinated. “Her answer is, ‘So I can see my dad,’ because she looked at me over and over again, sitting on our couch in our living room and talking to all of Washington state trying to move patients,” Mitchell said.

From their 10,000-foot view, WMCC staff can see how fragile the state’s healthcare system is and how close it is to collapse.

As fall sets in, Covid-19 cases and hospitalizations are declining. Paulsen said things looked a bit better.

But the standards remain high, everyone is understaffed and the beds remain full. And the phone just keeps ringing. WMCC received 18 calls in a recent 24 hour period.

“People keep telling me, ‘Well that’s better, isn’t it? And I’m like, ‘Well, you got on the Titanic lifeboat, but it’s not much better,’ “said Paulsen.

The coordination center is bringing more staff on board to help ease the load, and they hope eventually the call volume will come back to a manageable level so they can breathe.

As they prepare for potential future increases, the team encourages other states to put in place similar systems so that they can coordinate across borders.

For now, the team continues to respond to the pandemic one call at a time.


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