Code-red situation has local hospitals diverting patients

When Sara Nakagawa left Stevens Hospital in Edmonds recently after gallbladder surgery, she didn't realize how hard it was going to be to get back into a hospital.

About 10 days after surgery she began suffering from complications and waited in Stevens' emergency room for six or seven hours to be admitted. In pain, she called her doctor, who said he couldn't find hospital beds, either.

So Nakagawa went back home and called 911, determined to find a hospital that would take her. But the ambulance that picked her up spent 20 minutes in the driveway of her Everett home, trying to find a hospital. The closest one taking any patients was in Monroe.

Just last week, the same thing happened to her 12-year-old stepson, Alexander Webster, who was in the midst of an acute diabetic crisis.

Although the boy's doctor and all his records were at Children's Hospital & Regional Medical Center in Seattle, it had no empty beds, the family was told, and he would have to be transferred to Swedish Medical Center in Seattle.

It was the only pediatric bed open from Everett to Tacoma, Alexander's family was told.

"We have really struggled"

More often than expected, emergency rooms at hospitals around Puget Sound closed their doors this winter, as flu, respiratory illness and insurance problems brought patients to emergency departments in droves.

As a result, hospitals around the region signaled a central ambulance-routing system to alert that patients must be diverted to other hospitals.

This winter, virtually all hospitals in King County have been closed to emergency patients as often as six times a month, said Chris Martin, former chair of the Central Region Emergency Medical Services & Trauma Care Council.

"We have really struggled," said Martin, whose group helps set hospital-divert policy. "You can only hold so many patients in your emergency departments, waiting to get a bed upstairs, before you don't have a functioning emergency room."

It's been bad all winter, she said. "We have not had a break since November. The rest of the council is worrying that this is going to be ongoing."

Here's the problem: If hospitals in Pierce County start closing emergency-room doors, ambulances start taking patients north. When it happens in Snohomish County, ambulances head south.

Soon, all the hospitals are showing up "red" on a shared Web site that lists bed status so that ambulances can be routed to the closest hospitals.

"It's all over the state"

Two years ago, the trauma council adopted a policy that hospitals in King County would no longer divert when their own emergency departments or critical-care beds were full, or when they had staff shortages.

They agreed to stabilize critically ill patients, then send them to other hospitals.

That's still true for patients in life-threatening situations.

But patients who are not on the brink of death often have faced longer ambulance rides this winter, Martin said.

The cause of this problem is complex, all agree.

Population — and age — is increasing, said Rob Menaul, senior vice president of the Washington State Hospital Association. He also points to patients without health insurance who postpone seeking care and to a shortage of primary-care physicians.

A health-care-worker shortage sometimes means an available bed can't be filled.

"If you don't have a bed with a nurse attached to it, it's not a bed," Martin notes.

Menaul said such wintertime crowding is not new.

Jack Kirkman, vice president of Stevens, added: "Yes, divert is a problem common to hospitals in Snohomish County — but it's not just Snohomish County, it's all over the state."

At Children's, Chief Nursing Officer Susan Heath said in a memo that January was unusually busy.

"This overcrowding is unprecedented in my 25 years at Children's."

Statistics collected by the hospital association show that from December 2006 through March 2007, hospitals in King County had nearly 6 percent more patients than the rest of the year, Menaul said.

"Hospitals are busier every winter," he said.

This summer, Martin said, a new tracking system will help route ambulances to hospitals around King County more efficiently. And Harborview Medical Center, where Martin is administrative director of emergency and trauma services, will open 50 new beds.

"We, as hospitals, are very concerned about this, and we're working very collaboratively to fix the problem," Martin said. "You may not be able to go to your hospital of choice, but we are working very hard to make sure you will get to a hospital."

Carol M. Ostrom: 206-464-2249

costrom@seattletimes.com