Hospital understaffing is leading to patient deaths, health officials say

This article was republished from the Oregon Capital Chronicle.

People in Oregon are dying as a result of understaffing in the state’s hospitals.

Patrick Allen, director of the Oregon Health Authority, told a state legislative committee Thursday that people needing intensive care often have to wait to be admitted because hospitals are understaffed. And this, he said, could 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 Senate Interim Committee on Health during an information hearing. “This is really as big a crisis as we’ve had in the entire pandemic.”

As some patients are waiting for an appointment, others cannot come out. At any given time, about 700 people are either languishing in hospitals waiting to be discharged because facilities offering a lower level of care are understaffed or stuck in emergency rooms waiting for a hospital bed, Allen said.

His testimony came a day before the Legislative Emergency Council considered a $40 million request from health authorities 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 for hiring 50 more contract nurses.

Hospital professionals say these proposals will only provide short-term relief and help only certain sectors. The staffing crisis is widespread, affecting both medical and psychiatric facilities, including Portland’s Unity Center for Behavioral Health, Oregon’s only licensed 24-hour psychiatric facility. 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 unusual for us to have patients who are here for more than six months because we just don’t have a way to get them out of the hospital,” Eckstein said.

The state lacks residential care beds and wait times for outpatient care are too long, Eckstein said. Research shows that patients should receive outpatient care within a few days of leaving the hospital to have a chance at improvement, but wait times in Oregon can be as long as three months, she said.

Administrators say hospitals, clinics and long-term care facilities are short thousands of employees, from primary care physicians and assistants to nurse practitioners and medical assistants. As a result, hospitals have had to turn people away while others show up in emergency rooms and leave because the wait is so long.

Hospital staff shortages have affected ambulances, which sometimes have to wait for patients to be admitted. (Lynn Terry/Oregon Capital Chronicle)

Ambulances affected

Frank Ehrmantraut, who directs paramedics and emergency medical services for the Polk County Fire Department, told the commission it should only take 20 minutes to check in and admit a patient after an ambulance arrives at a hospital, but sometimes his employees have to they are waiting with a patient for a bed.

“They can sit in this hospital hallway on our gurney, being cared for by our paramedics, sometimes for up to two hours,” Ehrmantraut said.

Sometimes even the corridors of the hospital are full.

“In one case, the hospital was so full that there was physically no room for the emergency physicians and paramedics to stand with the gurney in the hallway,” Ehrmantraut said. “The patient had to stay in our ambulance in the ambulance car park for an hour and a half to get a 20 minute procedure.”

The reasons for the staffing shortage are numerous, said Becky Hultberg, president and CEO of the Oregon Hospital and Health Systems Association. Oregon has the lowest number of hospital beds per capita in the country, she said. In the past two and a half years, many baby boomers have retired, stress and burnout have pushed nurses and other professionals away from health care, and the industry has been hit, like others, by the “great resignation” during the pandemic.

Also, hospitals are losing money. Revenues are stable, but expenses such as personnel and pharmaceutical costs continue to rise, Hultberg said.

“This 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 rooms and delayed care, said Cheryl Wolf, 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 emergency visits a year, Wolfe said.

“Salem Health has been over 100 percent capacity almost every day for the past two years,” Wolf said.

It hired 330 contract professionals, which cost far more than staff, but even that wasn’t enough to meet demand, Wolfe said. This summer, the hospital decided to close its doors to non-critical ambulances for the first time since 2008.

“We saw a small decrease in patient volume after we implemented a diversion policy, but we continue to see high volumes as we prepare for our busiest months,” Wolfe said.

Health professionals are preparing for fall and winter, when respiratory infections tend to increase as people gather indoors. And although Covid infections have declined, new variants may rise, Allen said, at a time when many people have thrown away their masks.

The Oregon Capital Chronicle is part of the State Newsroom, a network of newsrooms supported by grants and a coalition of donors as a 501c(3) public charity.

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