For nearly three years, Oregon’s hospitals have faced surge after surge of patients sick with COVID-19. They filled hospital rooms, overflowed into hallways on gurneys and jammed emergency rooms, with hours-long waits.
But the current crisis involving a disease called RSV, or respiratory syncytial virus, that primarily affects children along with influenza, other diseases and COVID-19 is one of the worst the state has faced to date, hospital officials told a state legislative committee on Wednesday.
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“This public health emergency literally constitutes the greatest threat to children’s health in our state that we have seen in the last 30 years,” Dr. Dana Braner, chief physician at Oregon Health & Science University’s Doernbecher Children’s Hospital in Portland, told the committee.
The hearing of the House Interim Committee on Health Care came a few hours after Gov. Kate Brown issued an updated executive order to help hospitals meet the demand. Her first order on Nov. 14 addressed pediatric hospitalizations. Wednesday’s update extended the order to adult patients. It allows hospitals to draw upon a pool of volunteer nurses and doctors to bolster staffing and to be more flexible in staffing shifts. Nurses, for example, could end up caring for more patients than usual.
“Our health care workers – our nurses, doctors, and hospital staff – are being pushed to their limits by this year’s combination of flu, RSV and COVID-19 hospitalizations,” Brown said in a statement. “As they do everything they can to keep Oregonians healthy and safe, we must all do our part to help them.”
Oregon hospitals stop non-emergency pediatric proceedures, add overflow capacity
OHSU has stopped all non-emergency pediatric procedures, added overflow capacity by putting beds in hallways and conference rooms and doubled up patients in rooms to be able to care for all the patients. Doernbecher, Legacy Health’s Randall Children’s Hospital and Providence St. Vincent Medical Center have implemented crisis standards of care. They allow hospitals flexibility in assigning duties and devising schedules and give them the ability to triage care if resources run short. Each hospital has its own plan which is only implemented in crisis situations.
The surge of patients is not just in pediatric units, either. Adults sick with COVID and other ailments are crowding hospitals, and many of them are sicker than they were in the past because patients delayed care during the pandemic, said Dr. Renee Edwards, chief medical officer at OHSU.
“Patients are coming to us sicker than they were prior to the pandemic,” Edwards testified.
Edwards said it’s not just OHSU that is squeezed. All hospitals in the state are struggling to care for patients.
“The state is having trouble admitting critical patients,” Edwards said.
During the pandemic, Oregon hospitals have had a bed vacancy rate of about 8% in general units, with up to 12% of intensive care beds free. But now only 5% of all hospital beds in Oregon are available, Patrick Allen, director of the Oregon Health Authority, told the committee
Oregon has among the nation’s lowest number of hospital beds per capita, and has the lowest ratio for pediatric beds, Braner said.
State and hospital officials say that staffing is the biggest problem. Hospitals can find beds, but they need nurses, respiratory therapists and medical assistants to care for patients.
Hospitals and other health care facilities have been short staffed throughout the pandemic. Without enough staff for beds in units, they’ve ended up “boarding” patients in emergency rooms while they wait for a bed to open up.
Peter Graven, director of the Office of Advanced Analytics at OHSU, told the committee that in recent weeks the number of patients stuck in ERs has reached more than 330.
The Oregon Health Authority is seeking more money from the Legislature to help hospitals deal with the immediate crisis by bringing in out-of-state nurses on temporary contracts. Last week, state officials told the Capital Chronicle that they were bringing in 112 nurses and respiratory therapists specialized in pediatric care for Doernbecher and Randall Children’s Hospital.
Dave Baden, chief financial officer at the health authority, said new contracts for short-term staff would range from four to 10 weeks.
“We are bringing in who we can find,” he told the committee. “This is fast and strong but not long term.”
He said the cost for 10-week stints could soar to $25 million.
Patrick Allen, director of the Oregon Health Authority, told the committee that all state hospitals are under pressure.
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“Most hospitals are experiencing staffing shortages,” he said in a presentation before the committee.
The Oregon Association of Hospitals and Health Systems said in a statement that while the governor’s executive order was welcome, hospitals need more staffing flexibility year-round.
“The reality is Oregon hospitals need the ability to adjust their staffing all of the time, not just during a surge that has intensified our capacity crisis,” Lisa Goodman, an association spokesperson, said. “We have critically ill children in adult units and boarding in emergency departments who should be in pediatric intensive care units in Portland, but there are few available beds. We’ve been saying it for more than two years: our system is failing. The unfortunate position we find ourselves in today could have been prevented, and it wasn’t.”
Effect on nursing staff
The Oregon Nurses Association said the governor’s executive order was necessary but “embarrassingly late and lacking in strong solution-driven policy directives.” The group raised concerns that this will provide another avenue for hospitals to skirt existing nurse staffing plans.
“It opens the state’s coffers to wealthy hospital systems which have billions of dollars in cash reserves and heaps more stress on frontline health care providers who are already buckling under the pressure of these recurring surges,” the nurses union said. “More problematic is that this emergency order will give hospitals new ways to willfully ignore Oregon’s nurse staffing law – a law that most hospitals in Oregon already flout without consequence.”
The nurses union raised concerns about hospitals’ staffing plans that fail to follow the requirements in state law in areas such as meal and rest breaks for nurses and minimum staffing levels. The group pointed to an Oregon Health Authority survey and records that show 24 of 25 hospitals with visits from the authority have received citations for repeated violations.
The nurses union says unsafe staffing leads to turnover, and its own statewide survey of nurses bears that for 99% of hospital units.
“Nurses are leaving the hospital bedside in record numbers, and the recurrence of capacity crises like the one we are facing now is at the heart of that exodus,” the union said.
There was some good news during the hearing: Oregon could be on the downside of the crisis. Graven, who has produced COVID forecasts throughout the pandemic, said that the surge of RSV patients in pediatric units appears to have peaked.
“We’re at some of the highest levels right now,” Graven said.
At the same time, flu cases are rising. “The timing is not good,” Graven said. “There is some more growth left in that.”
He said the crisis could slow by the end of the month.
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