Emergency care in Thurston County --> One promising relief valve on the horizon

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

A JOLT OF HEALTH

Reflections on a trip to Olympia’s only trauma emergency department

The community response to my last column, has been robust, filled with many more heartbreaking stories, insight from prior RNs, as well as a rant challenging my medical judgment.  

It became clear and sad to understand from my readers and contacts that the emergency care problems in Thurston County are longstanding, complex, and unsolved. I was further saddened to read that our challenges are unfortunately shared by numerous communities nationwide. (thanks to the Commenter who shared this link!). 

Nonetheless, this column is about us and our home. My intent in writing the last column was to expose the extent of the problem.  The goal was not to criticize the facility per se but to reveal the challenges in hopes this would set the stage for exploring solutions. Our communities’ medical resource problems are COMPLEX, as are their causes and so I expect will be finding solutions. That said -

The major emergency care obstacles boil down to a lack of resources – specifically ED beds and professionals to staff them.   

Upon my request, MultiCare’s Media Relation manager Scott Thompson set up a video conference for me with Will Callicoat, President of Capital Medical Center, and Alisha Cunha, RN Clinical Director of Neighborhood Emergency Departments. 

I learned some important demographics from Mr. Callicoat :

• Staffing is causing a ‘traffic jam’ nationally. There has been increased demand and medical staff shortages since the pandemic.
• Burnout has resulted in doctors and nurses leaving the field and retiring (some early).
• Replenishing and training medical staff (as well as eliminating the causes of burnout) will take time and resources with an eye toward future needs (which was not done and leaves us playing catch up). Medical professional training takes time in school while experience in the field develops efficiency and competency.  The loss of staff is a major skill drain.
• There is a shortage of primary care physicians that has been building for years (this is not news to us in the field). Why? Primary care specialties (family practice, general internal medicine, and pediatrics) are the lowest-paid and the least respected physician specialties, for starters. Current financial support for medical education is abysmal, forcing young physicians to complete their education with large debt at high interest (unlike in the 1970s when I trained), leading them to choose higher-paying specialties instead of primary care.
• We are experiencing the painful duo of primary care doctor retirements and the lack of those to replace them in Thurston County, which is both growing and aging.

MultiCare locally has been committed to beefing up primary care in its system. Even with 25 primary care professionals (doctors and mid-levels) in 3 clinics in our area, those practices are full. Providence is also running Family Practice clinics in a handful of locations.

As for Emergency resources, there is a promising solution on the horizon and it comes from MultiCare, the ‘new’ non-profit owner of Capital Medical Center.

MultiCare is building a Neighborhood Emergency Department in Lacey (near Fred Meyer) that is set to open in mid-December. It is currently under construction.

When MultiCare (the first non-profit owner) acquired the for-profit Capital Medical Center in April 2021, they set about assessing the big picture in our area to fill ‘gaps of care.’ Emergency services turned out to be the top issue.  

Their goal is to provide a ‘fresh perspective’ in solving the need. Partnering with Emerus LLC (a corporate entity from Texas specializing in emergency care services), they have opened 4 Neighborhood Emergency Departments (ED) in the Tacoma environs. Lacey will be their 5^th.  These are also known as Off-Campus EDs. That is, they are off a hospital campus. Alisha feels their prior experience up north will serve as a helpful foundation for success with this new ED in Lacey.

Their management and organizational model for delivering care is intended to be innovative as well as comprehensive. Here are some examples:

• Time goals – 15 minutes ‘door to doctor’ and 120 minutes ‘door to discharge.’ Alisha reports these goals are close to being met in the Pierce County facilities.
• A TEAM model of care will include board-certified ED doctors and mid-level providers, RNs, RN residents and LPNs
• Diagnostic services on site will include Lab, Xray, CT, and Ultrasound
• After triage there will be a ‘fast track’ area for the most stable cases; their goal is to never have to tell a patient the triage rooms are full as it has been shown that the untriaged are the highest risk patients
• The facility will be able to address and stabilize all types of emergencies
• They will partner with both ambulance and helicopter transport services to hospitals as needed; so far in their other facilities, 3% of patients have required transfer
• The ED will have 10 beds and be open 24/7 taking patients of any age who show up in need of care regardless of ability to pay. Albeit small (this is the same # of ED beds as Capital Medical Center), their other EDs are this size and are seeing over 100 patients a day.

The administration is aware that this facility will not in itself solve the shortage of emergency services (or the entire scope of our problem).  They do intend for this facility to offer a ‘relief valve’ to the backup that so many have experienced in Providence St. Peter’s ED.

As for another trauma center locally, here is the story from Will Callicoat.  The prior owner of Capital Medical Center relinquished its trauma designation in the summer of 2020. Since MultiCare’s acquisition, Mr. Callicoat has inquired with the state twice to reinstate their trauma designation. They have been rebuffed by the Department of Health as recently as 6 months ago, reiterating as they did in April 2021 that they were taking no new claims due to the revamping of their ‘rule-making’ still in process.

I have reached out to 9 state senators and representatives to discuss ways the legislature might intervene to assist with the shortage of emergency care. Pushing that process along may be one way.  A single state representative responded. She and I have an appointment to speak after this column is published, so stay tuned.  

I have yet to hear back from my inquiry to media relations for Providence Swedish to discuss their plans for service improvement. No employees, many seeking relief from the workload burden – who no doubt have ideas for process and staffing revisions, have felt free to talk to me and risk their employment.  A commenter in The Jolt suggested a St Peter’s ED advisory board be formed with five members to include me!

This upcoming relief valve, with its fresh perspective and innovative processes and goals, is encouraging and hopeful for our community that has had to settle for ‘business as usual’ in emergency care for too long.

Time will tell how much of the burden this new ED will relieve and how well their admirable effort will succeed, but I believe it is one our community needs and should welcome.  Gratitude goes to the MultiCare administration for taking the time to communicate with me and thus to our community.

Post Scrip:  Thank you to those who expressed concern for my son. He had surgery for his injury (called the ‘terrible triad’ of elbow trauma) and is improving daily, hoping to soon return to his active life and passions (cooking and playing the cello) as well as recovering enough to fully participate in his UW graduate program and assistantship beginning next month.

Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com