PORT ANGELES — Staffing challenges and full beds are the leading causes of long wait times in the emergency department at Olympic Medical Center, according to hospital staff members.
On any given day, the emergency department at OMC has between 60 and 90 patients, according to Aaron Possin, director of emergency services. He said that the average is 68 to 70 patients, though there have been situations where the ER has had over 90 patients come in.
“Basically a patient may be in the waiting room for 8 to 14 hours but is seen by a provider within 30 minutes,” Possin said. “We just don’t have a bed for them yet.”
Possin said that emergency room patients are seen by either a physician, nurse practitioner or nurse within the first 30 minutes to be evaluated. Lab or imaging work may also begin. But it may take several hours to get them into beds or transfer them to another facility.
“We are experiencing the same bed crunch that other hospitals along the I-5 corridor are experiencing and it’s causing a trickle-down effect to where we are holding patients longer than we used to hold them in the ER which is, in turn, causing longer waits for patients in the triage area,” Possin said.
Most of the ER staff today are on locum tenens — temporary — contracts, according to Dr. Scott Kennedy, chief medical director, who noted that these temporary contracts are a heavy cost to the hospital, between $2 million to $4 million annually.
Kennedy presented OMC commissioners with an update on the emergency room transition on Wednesday.
Kennedy said later that when OMC hired Sound Physicians to take over the ER after the hospital suddenly ended its contract with Peninsula Emergency Services Inc (PESI) in June 2022, it asked Sound Physicians to staff the emergency department to the same level that PESI did.
But since then, Sound Physicians, which took over the operation of the emergency department in October, has struggled to hire providers, he said.
Later, Kennedy said that the number of patients and difficulty statewide in moving patients to other hospitals has led to scarce bed space in the emergency department and that this, combined with staffing issues, has resulted in seeing patients in the waiting room.
“Due to the volume of ER patients and the difficulty statewide to move patients from the ER to the hospital or to other facilities, we have moved the beginning of care into the waiting room,” Kennedy said.
“We have put in place rapid medical exams so that patients in the emergency room waiting room area are being seen either by a physician assistant or nurse practitioner to talk with them and then take them into a triage room and get lab work and imaging ordered started, in some cases begin treatment,” Kennedy said.
Said Possin: “What we are doing to kind of combat that new reality is we have up-staffed our triage area by putting a provider on triage, more nurses on triage and we have a dedicated ER tech to be out in triage so that way patients are getting their care initiated and started in a timely manner even if they can’t get to a bed.”
In June 2022, when OMC suddenly dropped its contract with Peninsula Emergency Services Inc. — which had provided physicians for the hospital’s emergency room for early 35 years — many of the physicians that had worked with PESI left OMC or continued to work only on a locums tenens contracts.
Then, OMC administration said that the hospital’s emergency department would be fully staffed by credentialed emergency services providers come July 1.
Kennedy told commissioners that he expected a transition time of 16 to 18 months and that the aim was to have all recruitment finished this year.
“As of Feb. 4, we will be four months into our work with Sound,” Kennedy said. “The goal of that recruitment effort is to bring in 12 new physicians and three new advanced practice providers (APP) and to hire a new ER medical director.
Possin said there have been weekly interviews of physicians and providers, with some starting later this month.
“I know that we are interviewing for new physicians every week and I know that we have permanent physicians and advanced practice providers that will be starting this month with several more starting in July,” said Possin.
Possin also said that the nursing staffing has increased since Sound Physicians take over the ER, but emphasized the need for physicians.
“Nursing staffing is significantly better, but provider staffing is exactly the same as it was,” Possin said.
“When Sound came in, it signed a contract saying they’re going to provide the exact same coverage that PESI did,” he added.
Kennedy and Possin broke down the current coverage in the ER.
“On a given day there are 12 nurses, four ER technicians, two physicians, and one APP,” Possin said.
APPs can be nurse practitioners or physician assistants.
Kennedy said the ER has at least two physicians between 6 a.m. and 7 p.m. with a third physician coming in at 4 p.m. and a fourth physician coming in at 6 p.m. to cover the evening shifts when the ER is often at its busiest.
“What we want to do is keep two or three physicians in the ED during the busiest times,” he said, adding that from 11 a.m. to 11 p.m., there are also nurse practitioners and physician assistants on hand.
Reporter Ken Park can be reached at firstname.lastname@example.org.