When hospitals are overwhelmed and out of options, they all call the same number

Rural hospitals in Washington state have been slammed with Covid patients, most of them unvaccinated.

Before the most recent surge, many healthcare facilities were already at capacity. The influx of patients driven by the delta variant kicked things up a notch, meaning patients of all kinds are finding it difficult to get a bed.

Over the past few months that’s led to hundreds of patients being shuffled around the state in order to receive care, and prevent facilities from hitting crisis levels like those seen in other places.

The Washington Medical Coordination Center (WMCC) — run by a small team at Harborview Medical Center in Seattle — is the body helping to move patients around.

In normal times, when a hospital has a patient they can’t take, they handle it themselves. They call their network and find an open bed.

The problem hospitals are running into these days is that the places they’d normally lean on are also full.

When hospitals are out of options, they all call the same number for WMCC.

“If they’re calling us, it’s because that system failed,” said Mark Taylor, director of operations for the coordination center.

Taylor said the pandemic is not impacting all areas equally.

“The only strategy we have to deal with that is to balance that, to spread that impact across all of the healthcare continuum.”

This means people in Washington can still get the care they need, and hospitals avoid hitting crisis levels.

But shuffling patients around also has some drawbacks. People can end up hours away from their family and community, and small communities can be left with depleted ambulance services for extended periods as the patient is driven to a different part of the state.

“But the bottom line is, while we try to keep the patient as close to their community as possible, we have to find a place that can support them safely,” Taylor said.

Every week patients are being transferred from the east side of the state to the Puget Sound region.

Almost all of the calls the coordination center is getting are coming from small, rural hospitals, according to its staff. And the number of transfers have skyrocketed in recent months.

From November of last year through the end of June, WMCC got 285 calls for help.

Then delta hit. From July through mid-October, they received 1,313 requests to transfer a patient.

“That is a real signifier of how incredibly stretched our healthcare system has been in our state when the backstop has to be used that many times,” said Dr. Steve Mitchell, medical director for WMCC.

And the phone keeps ringing.

On a recent Wednesday, Maria Paulsen is the person staffing the phone line. Paulsen is the programs operations manager for the coordination center.

When calls come in she gets details about the patient’s condition, where they are, what they’ll need, which facilities the hospital has already called in search of a bed, and then she takes that search statewide.

When Paulsen calls asking to transfer a patient to a hospital there are three main responses she can get; yes, no, or the patient gets put on a waitlist.

If there's an emergency and everywhere is full, Paulsen has the latitude to pull some strings. Unlike any individual hospital, the WMCC team has agreements with hospitals statewide that in some situations they can direct a facility to take a patient, and that institution simply has to make it work. It's not a card they play unless they have to.

On the day I meet with Paulsen she’s coming off a night shift with the phone. She’s working out of a conference room at Harborview Medical Center, although sometimes she works out of a closet in her home.

Screens in front of her show hospital capacity across the state.

There are a lot of zeroes.

“It tells me there’s not availability in our state,” Paulsen said.

Every 20 minutes or so her train of thought is interrupted by the loud, jangling sound of her ringtone. Her kids hate it, and it drives her husband crazy, she said.

But it’s loud, and it catches her attention, so it stays.

“WMCC, this is Maria.”

This is a phrase Paulsen has said over, and over again. During the summer, the call volumes to the small WMCC team exploded.

They were getting 20 – 30 calls in a 24-hour period. It took over.

Paulsen answered calls in the grocery store. Her colleagues had to hand off duties to one another just so they had enough time to drive home without having to pull over to answer a call.

All the while, the team juggled their day jobs in the hospital.

It was, as Paulsen describes it, “soul-sucking”, and it took a toll on their personal lives.

Paulsen said she and her husband can’t watch a TV show or a movie without it being interrupted. When she’s on the night shift she sleeps in another room so the phone doesn’t wake her spouse. It’s all-consuming.

Mitchell sees it in the response his 11 year old gives if asked why people should get vaccinated. “Her response is, ‘So I can see my dad,’ because she's watched me time, and time, and time again sitting on our couch in our living room talking to the entire state of Washington trying to move patients,” Mitchell said.

From their 10,000 foot view, the staff of WMCC can see how fragile the state’s healthcare system is, and how close to collapse it has come.

As fall sets in, Covid-19 cases and hospitalizations are declining. Paulsen said things look a shade better.

But levels remain high, everyone’s short staffed, and beds remain full. And the phone keeps ringing. WMCC got 18 calls in a recent 24-hour period.

"People keep saying to me, 'Well it's better, right?' and I'm like, 'Well, you've made it onto the life boat from the Titanic, but that's not very much better,'" Paulsen said.

The coordination center is bringing more staff on board to help lighten the load, and eventually they hope the call volume will go back to a manageable level so they can breathe.

As they prepare for potential future surges, the team is encouraging other states to set up similar systems so they can coordinate across state lines.

For now, the team continues to respond to the pandemic one call at a time.