Patrick Allen, director of the Oregon Health Authority, told the state legislature Thursday that people who need intensive care often have to wait to be admitted because hospitals are short of staff. That could lead to the worst consequences, he said.
“They could have had a good outcome, but in at least a few cases people have died waiting for this higher level of care,” Allen told the Senate Health Care Interim Committee during a media hearing. “It really is a major crisis as we have seen throughout the pandemic.”
With some patients waiting to get in, others can’t get out. At any one time, Allen said, about 700 people are either languishing in hospitals waiting to be discharged because facilities that provide a lower level of care lack staff or they are stuck in emergency rooms waiting for a hospital bed.
His testimony came a day before the emergency legislature is scheduled to consider a $40 million request from the state Health and Human Services Authority for hospitals that coordinate care in Oregon’s six hospital districts, clinical staff to coordinate patient transfers and funds to hire 50 other contract nurses.
Hospital specialists say these proposals will only provide short-term relief and will only help certain sectors. The staffing crisis is widespread, affecting both health and mental care facilities, including the Unity Center for Behavioral Health in Portland, the only licensed mental health facility in Oregon that is open 24 hours a day. Melissa Eckstein, head of the unit, said the facility ends up keeping patients in for longer than necessary because they also have nowhere to go.
“It is not uncommon to have patients here for more than six months because we simply do not have the means to transport them outside the hospital,” Eckstein said.
Eckstein said the state lacks residential care beds, and outpatient waiting times are very long. Research shows that patients need to receive outpatient care within a few days of leaving the hospital to have a chance of improving, but waiting times in Oregon can be up to three months, she said.
Officials say hospitals, clinics and long-term care facilities are short of thousands of staff, from primary care physicians and physician assistants to nurses and paramedics. As a result, hospitals have had to turn people away, while others show up in emergency rooms and leave because waiting times are too long.
Frank Ermantraut, who oversees paramedics and emergency medical services for 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 the hospital, but sometimes his crew has to wait with a patient on a bed.
“They might be sitting in the hospital hallway on our cash, being cared for by our paramedics, sometimes for up to two hours,” said Ermantraut.
Sometimes even hospital corridors are full.
“In one case, the hospital was so full that there was virtually no room for emergency medical teams and paramedics to stand with a stretcher in the hallway,” said Ermantraut. “The patient had to stay in our ambulance in the ambulance parking lot for an hour and a half for the 20-minute operation.”
The reasons for the staff shortage are manifold, said Becky Holtberg, president and CEO of the Oregon Association of Hospitals and Health Systems. She said Oregon has the fewest number of hospital beds per capita in the country. Over the past two-and-a-half years, many of the baby-boom generation have retired, stress and burnout has driven nurses and other professionals away from health care and the industry, like others, has taken a hit with the “big resignation” during the pandemic.
On top of that, hospitals lost money. Revenue is flat, Holtberg said, but expenses such as staff costs and medication continue to rise.
“This is not sustainable and calls into question the long-term viability of our community hospitals,” Holtberg told the committee.
Cheryl Wolf, a registered nurse and president and CEO of Salem Health, said the crisis was having an immediate impact on patients, with longer waiting times, communal occupancy rooms and delayed care.
Wolf said Salem Health has the busiest emergency departments in Oregon and Washington, with more than 100,000 emergency visits annually.
“Salem’s healthy energies have been over nearly 100% every day for the past two years,” Wolf said.
Wolf said the company hired 330 contract professionals, costing them significantly more than employees, but even that wasn’t enough to meet demand. 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’ve seen a small drop in patient volumes after we implemented the diversion policy, but we’re still seeing significant numbers as we prepare for our busiest months,” Wolf said.
Healthcare professionals prepare for the fall and winter, when respiratory infections usually rise as people gather indoors. Allen said that although Covid infections are declining, new variables could increase at a time when many people are giving up their masks.