Across the state, a health care system that has largely risen to the challenge of managing more than 100 young children hospitalized with respiratory syncytial virus is facing a new stress test: a sharp increase in adult patients with influenza and COVID-19.
There may be relief on the horizon soon. Epidemiologists hope RSV cases in Oregon may have peaked this week and could decline rapidly over the next month.
But in the short term, there are signs that the state’s overburdened health care system could run out of staff, or beds, or both, as it faces its first full season of respiratory viruses with COVID, influenza and RSV all circulating at the same time.
In southern Oregon, a small coastal hospital said it was operating to crisis care standards this week as it struggles to manage patients who need surgery and cardiac care urgent.
“Our community’s healthcare system is constrained,” said Virginia Williams, CEO of Curry General, the southern Oregon hospital that declared the crisis. “That would be a story in itself. The problem is that there are constraints everywhere.
In Portland, the Multnomah County public health officer reports that all emergency department waiting rooms in the city are all full and she is urging people to start wearing masks indoors again to reduce the viral transmission and prevent hospitals from being overwhelmed.
“Just put a mask back on when you’re indoors with other people,” Dr. Jennifer Vines said, stressing that her recommendation was for “personal voluntary action” and not a government mandate.
Coastal Community Hospital Struggle
Curry General, an 18-bed hospital in Gold Beach, Oregon, told state officials on Wednesday that it was operating at crisis care standards.
Curry General largely serves an older population, not children, and it made the crisis care announcement after adult patients flooded into its emergency department and staff struggled to find places to transfer adults who needed a higher level of care.
In the Portland area, three hospitals announced last week that they were moving to crisis operations, particularly in their pediatric intensive care units. These hospitals have added pediatric intensive care beds and increased the workload of nurses to cope with an increase in the number of very young children hospitalized with RSV, a typical childhood virus that is causing an unusual number of hospitalizations this year. .
Related: OHSU goes into emergency mode as severe pediatric cases rise
Curry General is a critical access hospital that provides the lowest level of trauma care available in Oregon. The emergency department stabilizes the sickest patients there until they can be transferred elsewhere in the region, usually patients are transferred to Bay Area Hospital in Coos Bay or one of the hospitals in Asante in Rogue Valley who provide intensive care and more specialized services.
With emergency departments and hospital beds filling up across the state, the time it takes to get patient transfer requests approved has increased “exponentially,” said Curry General CEO Virginia Williams. .
The hospital is especially concerned about patients who need cardiac care. Curry General can stabilize heart patients, but doesn’t have a heart catheter lab, which means he’s unable to diagnose or clear blockages in arteries or perform procedures like heart surgery or heart surgery. placement of a stent.
Williams says ideally heart patients only stay at the Curry General for an hour or two.
But this week, a heart patient at Curry General waited 54 hours before being transferred to a hospital that could provide a higher standard of care. Another patient waited 36 hours.
“Our detention, every minute, is really dangerous,” Williams said. “It’s not good.”
A third patient with bowel obstruction was also forced to wait much longer than normal for surgery, increasing the risk of perforation as there were no available surgeons in the area when the patient arrived. patient.
Curry General is not turning away any patients, although emergency room wait times have climbed to about eight hours.
Williams said she made the crisis care standard statement because the public “has a right to know what to expect when they go to the emergency room.”
This week, the hospital still has enough staff to treat everyone, but with several weeks of respiratory season ahead, staffing could also become a critical issue for Curry General.
“We just can’t keep burning out the staff we have, and yet we don’t have a very good plan to replace them,” she said.
Full emergency departments across Oregon
Dr. Alex Skog is president of the Oregon Chapter of the American College of Emergency Physicians. He works in the emergency department at Providence Willamette Falls Medical Center.
Skog says Curry General’s decision to declare he is operating under crisis care standards is unusual, but the pressures he faces are not.
Since the start of the pandemic, the time it takes for small and rural hospitals to transfer patients who need a higher level of care has increased, in some cases drastically.
“It’s another wave in what has been a three-year long crisis,” Skog said.
He said he recently cared for more than 50 patients in a 20-bed emergency department.
“Despite the best efforts and fantastic training of everyone working at my hospital, it would be wrong to say that I can provide the same level of patient care that I would have in 2018,” he said.
Masking, other measures, could preserve hospital capacity
In Multnomah County, health worker Dr. Jennifer Vines emphasizes what people can do to reduce viral transmission.
Vines is asking people to take precautions, including getting a flu shot and a COVID shot or booster, washing hands frequently and masking up in crowded indoor spaces through Jan. 1.
Vines said she’s not asking people to cancel plans for gatherings, but she recommends masking for everyone in crowded indoor settings, including daycares and schools.
The flu and COVID-19 strain comes as Portland-area children’s hospitals say they have successfully expanded operations to deal with a historic rise in pediatric hospitalizations for RSV.
And data from the past two weeks gives hope that the RSV crisis may have peaked. The number of hospitalizations fell the week of Thanksgiving, before climbing slightly this week. The percentage of positive RSV tests stabilized at around 23% after climbing rapidly in late October and early November.
OHSU’s Doernbecher Children’s Hospital and Legacy’s Randall Children’s Hospital have added dozens of additional beds for the sickest children by converting single rooms to double rooms in their pediatric intensive care units. In Doernbecher, the hospital will begin adding pediatric intensive care beds in other peak areas, said Dr. Carl Eriksson, pediatric intensive care specialist at OHSU.
Both hospitals accept transfers of children from across the state and there is no waiting list for admission to pediatric intensive care.
“The goal here is that we are able to provide care for every child who needs our care,” Eriksson said.
Another pressure on the system right now is parents bringing in children who don’t need hospital care.
Related: How to treat a child with RSV safely at home — and when to call the doctor
In Randall, only about 10% of patients assessed in the emergency department are admitted to hospital.
Dr Wendy Hasson, medical director of Randall’s Pediatric Intensive Care Unit, said it’s extremely important for parents to understand that children should not be taken to the ER just because they have been exposed to RSV and that the parents want a test.
“Seeking care for testing alone is not an appropriate use of resources at this time and contributes to overwhelming emergency services and urgent care,” Hasson said.
For any child who has general cold symptoms, knowing the name of the offending virus doesn’t change their treatment, Hasson said, “because dealing with all of these viruses is supportive care.”
Parents also don’t need to take children over 2 months to the emergency room just for the fever.
Reasons for seeking emergency care are if a child is having trouble breathing, showing signs of dehydration, or is listless and no longer wants to eat or play.
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