Coming to St. Michael Medical Center in an ambulance? Get in line

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Frustration has been mounting among Kitsap Fire Departments in recent weeks over long delays, sometimes hours, for ambulances waiting to drop off patients at St. Michael Medical Center.

As the minutes tick by at Silverdale Hospital, patients wait for the care they need and emergency responders stand by, unable to return to service in the community.

In interviews with the Kitsap Sun, Kitsap County fire chiefs sounded the alarm about conditions at the Silverdale emergency room, describing a “crisis” situation at the community’s only hospital.

Statistics provided by Poulsbo Fire Department Chief Jim Gillard, who also chairs the Kitsap County Fire Chiefs Association, showed that of the nearly 1,000 transports to hospital emergency rooms by Kitsap EMS agencies in July, just over 12% saw a medical unit waiting. more than 30 minutes to hand over a patient to hospital staff. Nearly 6% saw wait times over 60 minutes. Seventeen hospital transports waited more than two hours and seven cases lasted more than three hours.

Gillard identified August 12 as the worst day for delays yet. That day, Kitsap agencies made 41 trips to the hospital, and about a third of those trips saw a wait time of more than 30 minutes. A quarter of these trips had a waiting time of more than 60 minutes. The longest delay that day: a breathtaking six hours and 22 minutes.

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Gillard expressed his sympathy for the nurses working at the facility and his frustration with the hospital administration, pointing to what he said were increasing cases of patients whose condition deteriorated. deteriorated while they waited.

“I think we’ve done everything we can to work with the management staff at St. Michael on this, and we really don’t feel like they’re interested in handling this,” he said. -he declares. “We have cases where it has affected patients. I feel like it’s on me, I have to do something, I can’t take another patient who’s going to sit on the stretcher while our teams call for (emergency) staff to treat them, and they get worse.”

Bainbridge Island Fire Department Chief Hank Teran said that, on a scale of 1 to 10, his level of concern about the situation had reached 10. His frustration was two-fold, he said. -he said: first, with the time it takes for patients to be seen, and second, that staff cannot return to the community for further emergency calls.

“It’s a 10 because it transfers all levels of service to the community when we have our firefighters and paramedics who are unable to provide service to our community,” he said. “…When our people are there and they wait for hours, that’s the time they can’t train, that’s the time we can’t go out and provide community service, that’s the time It’s time we have to delay the training of our trainee firefighters. This weather has a trickling effect.

New Policies

In light of the delays, fire chiefs from across the county met Aug. 19 and agreed to a new model directive for their agencies that guides EMS personnel in situations where hospital delays s lengthen. Kitsap 911 dispatchers will track wait times for ambulances at the hospital, and if two units have been waiting for more than 45 minutes, incoming transports will automatically be notified of the delays.

Under these conditions, medical staff should consider taking patients to another facility after consulting with those patients, says the model policy that chiefs approved last week. “The ‘nearest’ facility may not be the geographically closest facility, but rather the facility that can provide the appropriate level of care as quickly as possible.”

Previously, Gillard said, medical units relied on the hospital to implement “diversion” status to send ambulances with patients to other locations when the facility is overwhelmed. In several situations, however, he said, hospital staff requested diversion status during peak periods and were denied by the administration.

“We didn’t receive that information, so we crowded our units into St. Michael’s because that’s the closest emergency department,” he said. “This is where we get to the point where we have a dozen EMS units in the hospital waiting up to six hours to transfer a patient’s care. These are all units that cannot then respond to emergencies. We have our automatic aid agreements, we cover calls, there will always be someone coming, it’s just that they won’t arrive as quickly because this unit may be in the hospital.

Said Teran: “Because St. Michael’s will not be proactive and will continue to divert, we are trying to decide what is best in the field now to divert to a hospital to provide care to our patients sooner. There have been times when our units have called, requested information from the hospital and sometimes the hospital has refused to provide information or turn away. We are the ones who have to take this into our own hands because of a lack of action on the part of the management staff. »

FILE - St. Michael's Medical Center in Silverdale in January.

Complex issues

South Kitsap Fire and Rescue Chief Jeff Faucett, who also chairs the Kitsap County Emergency Medical Services and Trauma Care Board, acknowledged that the difficulties at St. Michael’s Medical Center are being faced by the state and national hospitals and that the issues are complex.

A lack of space in long-term care or rehabilitation centers for patients ready to be discharged from hospitals can lead to a back-up system, he said, noting that staffing shortages, patients with mental and behavioral health needs and those who really need primary care more than emergency care, have all strained hospitals.

“Yes, you have this big, huge system problem that’s going on in the healthcare world and especially in your hospitals, but when you have a big county like Kitsap County with just one hospital, it’s a conversation hard and tough,” he said. said. “Fire chiefs, we just want to find a way with St. Michael’s to figure out how to get our ambulances in, offload the patients and get out of there so we can get back to our citizens, that’s what we’re asking.

In response to questions about the conditions highlighted by the Kitsap Fire Department, a public relations firm representing the hospital provided a statement to the Kitsap Sun attributed to St. Michael Medical Center Chief Nursing Officer Jeanell Rasmussen.

In the statement, Rasmussen said all hospitals in the state, including the Silverdale facility, “are experiencing extremely high capacity while continually struggling with staffing shortages, including in the emergency department.” and highlighted “post-acute care placement challenges that make it difficult to discharge some inpatients who are awaiting the establishment of guardianship.

Rasmussen said the hospital is using a command center to manage issues and said it is working to ease the pressure through “various strategies to make sure we can take care of all of our patients.”

The statement reported on a meeting with fire chiefs in July to discuss emergency department diversions, saying: “We understand their frustration and have been working with our emergency personnel and other hospital teams on strategies to decompress the emergency department before needing to continue divert status and have established additional trigger points to proactively identify the need for diversion.

FILE - A hallway of patient rooms at St. Michael Medical Center in Silverdale in October 2020.

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Fire chiefs stressed that people in need of care in emergency situations should simply call 911.

“Call us if you have a problem, we’ll come,” said North Kitsap Fire and Rescue Chief Dan Smith. “That’s not the problem. As a patient, don’t make decisions about what you think the wait time will be. I don’t want people to have that kind of image so they don’t call when they have a problem. I think we are all concerned about that. We will work with patients to make a good choice, getting them to the most appropriate facility where they will be treated as quickly as possible based on their current situation.

During a meeting with Central Kitsap fire and rescue marshals on Monday, Chief Jason Christian noted that it was his agency’s Medic 51 unit that had been waiting at the hospital for more than six hours over early this month.

“Now there are other calls going on in Medic 51’s service area,” he said. “You can imagine not only how nerve-wracking it is for the patient waiting in those hallways for six hours and 22 minutes, but for our first responders to listen in on those calls that are happening in their service area that they know that they can make a difference, but they are not allowed to respond.

Nathan Pilling is a reporter covering Bainbridge Island, North Kitsap and Washington State Ferries for the Kitsap Sun. He can be reached at 360-792-5242, [email protected] or on Twitter at @KSNatePilling.

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