Please let me first thank you for the amazing care that you and your teams are delivering in this time of unprecedented capacity and throughput challenges. I have heard from many of you of the disaster capacity plans you are engaging in, the near misses in your lobbies, and the stress your staff is under everyday in this flu pandemic. It is an honor to represent you in these times of challenge.
Washington ACEP has been attempting to advocate on the statewide level for solutions. In effort to ease capacity concerns at EDs in parts of the state, the WA-ACEP Board of Directors is advocating for statewide solutions and resources at multiple levels. WA-ACEP representatives have been in contact with the Department of Health (DOH), the Health Care Authority (HCA), the Washington State Hospital Association (WSHA), the Washington State Medical Association (WSMA), Chief Medical Officers, as well as the Northwest Health Care Network, among others. All are concerned about capacity and looking for ideas.
The findings as of Jan. 12 are:
- There is a national disaster declaration (1135) that could open a number of options, but this requires a presidential order. Probably not there yet and the politics in this time of transition are challenging.
- There are options for a state of emergency declaration. Standards are not well defined, but arguably we meet it. What results this would entail are unclear, but could be helpful in terms of relaxing certificate of need and other rules
- DOH is looking at supportive statements / instructions to hospitals about temporary relaxation of bed restrictions and to not worry about licensing concerns for temporary bed locations (e.g. inpatient rehab, other locations). Please see FAQs as of Jan. 13 to share with your leadership team and use as a resource.
- HCA is instructing Managed Care Organizations (MCOs) to get their patients out of the hospital with daily reports to Dan Lessler, CMO of Medicaid. This can include rate increases that your care managers can advocate for to assist in placement.
- DOH is exploring with the Attorney General and local public health officers the option of possible moratoriums on elective surgeries on a countywide or regional level and the legality of such a move.
- Concepts such as a MASH hospital for post-acute care are being explored if a disaster were declared.
What you can do:
- Talk to your C-suite – all care is local and staffing remains a problem, with or without DOH.
- Be ready to provide a snapshot reporting of information on board/capacity issues like we did for psychiatric board to add data to our conversation. WA-ACEP will provide more information as this idea evolves.
- Advocate for a no divert policy. We are all at capacity and once one domino falls, it has a long downstream effect. My current understanding is that February 1st King County is going no divert, let’s make it a goal that we all are ready by then.
These are challenging times. But we are emergency medicine. When the rest of the house of medicine falls, we rise. Out of this crisis, let us see this as a shared opportunity and forge out of this crucible a resolve to stop diversion and address systemic crowding.
Thank you for your continued perseverance. As always, please do not hesitate to contact me if I or we can be of further help.
Nathan Schlicher, MD, JD, MBA, FACEP