Overwhelmed Portland hospitals enter crisis standards of care

Faced with a shortage of staff and an increase in critically ill patients, hospitals in the Portland metro area have shifted to crisis standards of care.

The hospitals include Providence, Legacy Emanuel, Kaiser Permanente and Oregon Health & Science University – which often serve large parts of the state for critical and specialty care needs.

This is the first time the metro region’s health system has entered crisis standards of care for adults and pediatric intensive care units since the COVID-19 pandemic began.

Crisis in care standards, as outlined by the state, allows hospitals to stretch resources to deal with emergencies; for example by assigning more patients to each nurse or creating ICU beds in operating rooms.

When resources are truly not available to treat everyone, crisis care standards also allow hospitals to triage patients, essentially focusing on treating those with the greatest short-term chance of survival. The four health systems say they are not moving to triage patients and hope to avoid that scenario by adding beds and lowering nurse-to-patient ratios.

“If we fill all these beds and the volume goes up, that’s probably when we’re going to get there,” said Dr. Melinda Muller, the interim senior vice president and chief medical officer at Legacy Health.

ICU nurses, who often take care of a single patient at a time, will be assigned two patients, according to Muller. In other units, the ratio of nurse to patient may increase from 4 to 1 to 5 to 1.

Hospital equipment at Good Samaritan Hospital in Northwest Portland.

In this file photo, protective gloves and equipment are seen at Legacy’s Good Samaritan Hospital in Northwest Portland.

Alan Sylvestre / OPB

Most non-urgent surgeries that require an inpatient hospital stay will be canceled, Muller said, although hospitals will continue to perform as many outpatient surgeries as possible. Oregon hospital leaders say they are facing the worst capacity crisis they have ever seen, worse even than periods during the pandemic when the number of COVID-19 hospitalizations was higher.

Muller says that without emergency measures, patients with time-sensitive health emergencies — like strokes that require neurosurgery — could be forced to wait too long before receiving treatment in the intensive care unit.

In recent days, Muller says, the ICUs in the Portland area have struggled to admit transfer patients from hospitals in other parts of the state that depend on them to provide care for the most complex cases.

“People were waiting longer than we thought was appropriate to come here because of the bed capacity issue,” Muller said.

Washington faces similar capacity issues, limiting Oregon’s ability to handle the crisis by sending patients to neighboring states.

The statewide crisis has been building for months, fueled in part by a shortage of clinical staff, especially nurses. Many have cut their hours or moved out of the most stressful bedside roles. And a lack of long-term care beds for people with chronic conditions or psychiatric illnesses has meant that many patients are stuck in hospital much longer than necessary.

At the same time, Oregon is facing its first full winter respiratory virus season since dropping a statewide indoor masking policy. A rapid increase in respiratory virus cases in adults – primarily influenza, but also COVID and RSV – is making the situation worse.

State health officials say the number of RSV cases among children has begun to stabilize and should continue to decline throughout December, likely easing the strain on pediatric and neonatal care resources.

OHSU’s official respiratory forecast predicts the worst increase will be in December, with fewer hospitalizations expected in January.

Only hospitals in Portland have announced they have gone into crisis in care standards. Curry Health Network in southwest Oregon operated under these standards between November 30 and December 5.

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