Most of us have experienced delays related to supply chain problems, resulting from nearly three years of living and fighting with a pandemic.
Now that COVID-19 ebbs into endemic status and we can roam again, we realize some things are different — perhaps a lot of things. It is as if everyone was thrown up into the air and landed in a different place.
Health care is a good example. Right now, we are experiencing a health worker shortage that is seriously impacting our health care systems.
Look no further than Nextdoor, the email chain on which writers post sunset pictures and complaints about long waits in OMC’s emergency department (ER). The postings are angry and blaming, often with a recommendation to go to Jefferson Health Services ER in Port Townsend.
I can sympathize with anyone in the waiting room feeling very sick or with someone who is very sick. We are afraid and, the longer the wait the more afraid we are there will be no help.
At some point anger sets in, and we blame the hospital — in this case, OMC.
Given my long history working in the industry, part of which was in administration at OMC, I knew they do not like it either. I knew they would fix it if they could.
I, like most of you, get my local information from the Sequim Gazette or PDN. Over the last year, we learned about alleged sexual assaults by an ER physician that disrupted a long-standing relationship with the company that placed physicians, nurses and physician assistants in the ER. Of course it did not help, but as terrible as the allegations and disruption were, I did not think it was the only or most significant cause of ER delays.
So I asked. My inquiry was met with willing ears. I had the chance to talk with OMC CEO Darryl Wolfe and Bobby Beeman, OMC’s director of marketing and communications, to help me understand what was happening.
They explained the system was bottle-necked at most stops on the health care continuum.
Health care continuum
The start of my career in 1965 happened to coincide with the start of the Medicare program, a familiar program to older people, if not the young among us. I may have been full of youthful arrogance, but I thought it was a brilliant design of a health system, or continuum, that intended the patient to have the right care, at the right time, in the place and by the right provider.
I started my nursing career in public health which included visiting nurse services, the nursing service intended to help people remain in their homes. I chose public health because I believe people heal better in their own homes with those they love. I believe they, if terminally ill, die better as well.
Today, my husband Paul and I are beneficiaries of a Medicare program that helps us stay together in our home through the Medicare in-home Hospice care benefit started in 1983.
Medicare was and is intended to provide health care at an affordable cost to the patient, the providers of care and the program. The program is designed to have care provided at four different levels of care: acute care (hospital); skilled nursing/rehabilitation; intermittent home health, and outpatient services.
As patients improve, they transition to different care settings at less cost to the program. Makes a lot of sense … until it does not work.
The brilliant design of Medicare loses its shine when it is unable to transition patients through the system. OMC has an even greater transition imperative since it must transfer more complex patients to tertiary hospitals able to provide the required complexity.
Failure to transition results in a domino backlogging effect. When OMC must keep the patient in one of its acute care beds and its beds become filled, OMC’s ER must keep the patient in ER until a bed is available which creates a backlog in patients waiting for care in the ER.
Wolfe and Beeman explained that the backlogs are caused further stressed by health worker shortages across the region. Along with continual staff recruitment to fill its vacancies, OMC has taken measures to relieve the backlog and reduce waiting time, especially upon arrival in the ER.
The fix, when continuum does not work
First, they stressed the importance of going to the Emergency Department, the closest to the location in which the emergency occurs. In true emergencies, delays in care can have serious consequences. Patients with conditions requiring immediate attention to save lives and limbs are seen first.
Wolfe assured that as a Level 3 Trauma Center, OMC provides that care 24-7. If they could not, they may transfer an individual to another hospital that can.
The spillover of patients into the lobby that was done deliberately to create space between patients during the pandemic has become a necessity due to patient volume created by the COVID-related delays in care backlogs and bottlenecks. The ER has revised its procedures to see patients upon arrival and initiate lab or imaging services as needed while patients are in the waiting room/lobby.
If possible, patients are advised to seek care before the condition becomes an emergency. They remind us that walk-in clinics are an option when open. Sequim’s OMC’s outpatient clinic in Sequim is closed on the weekend due to, you guessed it, staff shortages. Available staff are used in the Port Angeles Walk-in Clinic.
OMC’s greatest challenge like every other health care center’s is recruiting and hiring provider and nursing staff. Recruitment has become highly competitive — with offerings of sign-on bonuses up to $10,000 for nurses, for example. Meanwhile, travelers, staff who fill in on a temporary basis are used to staff vacancies at considerable cost of higher wages and expenses.
Wolfe says the cost of labor for OMC has risen from 62 percent of expenses to more than 70 percent in the last two years. He says OMC is operating in the red, as are about 60 percent of the nation’s medical centers.
Care over complaints
We, the community, need to be concerned and at least support our local health care system. We need it and we are part of what makes it desirable for a health care worker to move to the area — it is medical care, housing, schools, welcoming neighborhoods.
Complaints without perspective are not helpful. Workers in health care suffered during COVID. The work was relentlessly hard, risky and sad, made worse by people who refused to see the consequences of the virus and heaped complaints on workers. Some healthcare staff retired or simply left the industry.
No one wants to wait in the ER for care. There is no one we would rather see than someone who can relieve our pain, our anxiety than someone who knows what to do.
We need them.
Let us, the community, support OMC in its efforts to bring the talent and skill of health workers to our community. We are a big part of appreciating current health care workers and welcoming those who would come to our community.
Be warned and be patient — the fix will take time and community support.
Bertha Cooper, an award-winning featured columnist with the Sequim Gazette, spent her career years in health care administration, program development and consultation and it the author of the award-winning “Women, We’re Only Old Once.” Cooper and her husband have lived in Sequim more than 20 years. Reach her at firstname.lastname@example.org.