Five miles northeast of the State Capitol is our community’s only certified trauma center. Providence St. Peter’s Emergency Department (ED) is typically overcrowded and known for long waits. This seems to be general knowledge in Olympia, at least during and since the pandemic.
It is one thing to be aware of and chagrined by this situation as a professional and community member. It is another thing to experience with a loved one. In a 7-hour ordeal, I learned more than I ever wanted to know about the shortcomings of this facility.
Last weekend, while on a joyful family walk in Squaxin Park, my 28-year-old son Elan Green, in his enthusiasm to get to the water, tripped on a root and fell hard. He was in shock (pale, clammy) and crying out in pain. I could see he had dislocated his elbow, that he could neither get up much less walk. Any movement of his joint would be excruciating and we were half a mile from the parking lot.
They arrived in force with at least 4 EMTs (Emergency Medical Technicians). They assessed Elan and expeditiously applied an inflatable splint to keep the joint immobile until it could be reduced (i.e., put back in place) by a doctor in the ED. The ambulance had been called and was on its way. The lead EMT kept me abreast of the process and assured me I could ride in the ambulance to the hospital.
The ambulance rolled a single-wheeled stretcher to Elan and a handful of EMTs lifted him into it from the uneven dirt incline. I sat up front with the driver, who shared that her primary employment is with the ambulance company in Gray’s Harbor County. She commutes there by choice, as the EMT rules within Thurston County are too restrictive for her taste. Relevant to my son, in another county the EMTs might have the authority under a doctor’s order, to give pain medication in the field. A joint out of place is a very painful condition.
The ED was a zoo. There were 40 people ahead of us in the waiting room who had been triaged and more arriving all the time.
1) Boldly, I walked in from the holding zone doorway and interrupted a nurse. How can I get my son evaluated for pain management? She said he had to get off the stretcher and into a wheelchair to take his place in line at the walk-in triage.
2) Elan wanted to do this despite the anticipated agony of moving. EMTs from 2 ambulance companies (not ED nurses who were swamped with patients) helped him into a wheelchair. I wheeled him to the walk-in line and the ambulance departed.
My son agreed to share his experience with the readers (in italics). He is a sophisticated patient being the son of 2 physicians and the first-degree relative of 4 more two of whom are Emergency Physicians. Plus, he did chart note transcription for his father and was a computer coder for a healthcare technology company.
The triage situation was egregious…to have to endure more pain to get into a wheelchair to wait in line to get triaged and then wait and get an X-ray. Compared to my experience in Texas it was staggeringly different.
He broke two bones while living in Texas. There he was seen in a private freestanding ED, evaluated, and medicated for pain upon arrival on the stretcher he came in on without needing to be moved.
3) He was second in line for RN triage. When his turn came up, the RN asked him what happened while I implored her to have him evaluated for pain management as soon as possible. She ordered the X-ray which needed to be completed before any treatment could be considered (a harsh policy that makes no sense to me).
4) Having been assessed, we (the whole family group of 5 that had been walking) took our spot with dozens in the waiting room.
5) Rather quickly, he was taken to X-ray. Soon after physician #1 came to get him for evaluation in a triage room. The doctor reviewed the X-ray and the patient (comminuted fracture – think multiple pieces of bone – and posterior dislocation) and ordered two injectable pain medications. To do so, the doctor had to argue with the charge RN about the ‘policy’ against medicating patients not yet ‘roomed’ (i.e., officially assigned to an ED room and thus a nurse) and succeeded.
6) This ‘new’ pain policy had been handed from the administration (for reasons unknown), rendering those caring for patients powerless to follow thru with their clinical judgment for managing acute pain (traumatic or otherwise).
7) Getting Elan a cool facecloth and ice pack while in the waiting room required another interruption of staff as he was yet un-roomed and thus not assigned to a nurse.
8) Finally, physician #2, who would be treating the dislocation came to take Elan to the procedure room himself. He and the staff had gathered a team of five staff to assist in the reduction procedure.
It’s worth noting a salient detail that the ketamine RN stayed 2 hrs beyond her shift and had to be back by 8 am, leaving her a 6-hour break from when she left me and how much sleep before her next shift?
Both RNs on the team (the anesthesia and splint-applying nurses) stayed >2 hours overtime to care for him.
9) The reduction was completed; the anesthesia recovery was emotionally traumatic (but considered normal) and I was glad to be allowed to be with him. The doctor arranged for pain medication to tide him over and made a referral to an Orthopedic Clinic in Seattle (where Elan lives).
Again, I interrupted an RN at her computer (seemingly on her own during this night shift – it was 0130 am) asking what we were supposed to do. She asked, “Do you think you can get him to your car on your own?” When I said, “Yes,” she walked back to her computer while I gathered the help of family members to do so.
When I worked in EDs…an RN discharged the patient themself, taking the patient in a wheelchair to their car making certain of a safe transfer out of ED care.
I got out of the procedure and no one told us what was next…if you are understaffed, you might want to prioritize getting people out of the beds to open them up.
Elan’s reflections on 7 hours in the St. Peter’s ED:
Addled (confused) experience by all the pain and the drugs yet…they were so far beyond their bandwidth. I felt forgotten and not their priority.The general feeling and atmosphere was total stress, chaos, and burnout which doesn’t translate well to a trauma care unit. That was staggering.I truly dread thinking about the scenario if I didn’t have a doctor Mom advocating for me …they did not have the resources to take care of people in distress.As far as I’m concerned, the whole thing could have taken 3 hours maximum.I feel compassion and understanding for the workers who are in a completely untenable situation. It is not fair to the patients to be burdened with the untenable nature of what the staff is going thru.Why are you open if the service is unavailable?Maybe it would have been better to take another 45’ ambulance ride to Tacoma and get out 4 hours earlier? We had seriously considered doing this because of the triage situation. I’d rather have endured the pain of driving to get cared for right away.In the end, I did feel that I got the best care I could have received albeit with the wait.
After the procedure, one of the staff nurses asked me, “What was JOLT on my cap?” I told them that in addition to being with my son, I was also a member of the press, the medical columnist for our local online news organization. The response from everyone in earshot was, “Please write about our dilemma.”
Two nurses chose to stay overtime working up to 16 hours to care for my son. That showed dedication and caring. The staff response to my JOLT cap was a cry for help.
Two doctors provided excellent care to my son.
There were no delays or glitches with 911, the Olympia Fire Department, or the ambulance company. Their care was prompt, competent, compassionate, and efficient. They were not short-staffed.
I am left pondering the organization's PRIORITIES and LEADERSHIP.
Is there nothing our community can do to have this untenable situation rectified?
This is our story. In a subsequent column (or more), I hope to share what staff and administration are willing to impart… if they will talk to me. I will report on the new free-standing ER being built by MultiCare in Lacey and more.
Accompany your loved ones to the ED. Insist on staying with them for the entire encounter and advocating for them as often as necessary.
Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com
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MelissaDenton
This is difficult to comment upon. I want to be supportive of the medical care providers at St. Peters, but dread of the extreme waiting times and minimal & delayed triage makes me very reluctant to go there. I'm a lawyer and previously worked in hospitals. I can advocate for loved ones, but I would go to extreme lengths to avoid St. Pete's emergency room facility. Hearing that emergency rooms in Tacoma may be more efficient makes me consider insisting on going there if a need should arise.
Wednesday, August 9, 2023 Report this
CPWINOLY
I hope that your son is recovering well. I dread sending patients to the ED at PSPH. Patients receive good care, but the waits are interminable. I have been told horror stories about people kept in the hallway for days. This is unacceptable for a city this size. We desperately need an alternative, not run by Providence.
Wednesday, August 9, 2023 Report this
Poodle
A friend sent me the article you wrote about your son's (and your) experience at St. Peter Hospital Emergency Department. I am sorry for your son and hope he is doing better.
I worked at St Pete's ED for nine years, finally leaving a year ago for many of the reasons you described in your letter. I could no longer work there and feel like I was able to provide safe and compassionate care for the patients and their families, nor for myself. I needed to get out for my own mental health! While many of the issues are specific to that ED and its policies, the larger problem is that our community does not have an adequate number of hospital beds for in-patient care and it all falls back on the ED. At any given time, half or more of the patients occupying beds (in hallways or otherwise) are actually admitted to the hospital but there are no beds for them on the inpatient floors, so they wait, often for days, in the ED. Clearly this causes a back-up to where there may be only 1 or 2 open ED beds to accommodate patients in need of emergency care. This is a very complex issue, but from my perspective, our community (and the surrounding 5 counties served by St. Peter Hospital) needs another large hospital. In the meantime, Providence-Swedish needs to stop being so profit-driven and actually pay their staff wages to compensate, attract and retain nurses at all levels. The majority of nurses in the hospital have assignments of 5-6 patients. It is absolutely impossible to provide safe care to that many people. Better pay, better working conditions would help increase staffing, which would open more beds, provide better nurse to patient ratios and trickle down to reduced back-up in the ED.
As far as the pain medication policy, I agree it is frustrating. I hated working the "greet desk" where people who were waiting would need immediate care but we were not able to help. There are many issues behind this, one of them being that if a narcotic is given, the patient is supposed to be monitored and re-assessed within an hour. As you can see from your experience, that is not practical. The fear being someone might get too sedated or their blood pressure would drop, or they would have another adverse reaction while they were in the waiting room and the staff would not know this. Also, if an IV is placed and the patient is sent back to the waiting room, it can and has been used by drug-seeking patients as an easy way to inject their drug(s).
As a side note, I am also a retired Paramedic-Firefighter with the Olympia Fire Department (25 years). It's true the EMTs in Thurston County cannot administer medications (except aspirin for suspected Acute Coronary Syndrome, and epi pens for anaphylaxis). However, they could have requested an ALS unit (paramedic) for pain management. Since your son was at Squaxin Park, they may have figured it was more efficient to transport him to the hospital rather than wait for the paramedics to arrive (of course, ultimately its possible the medics would not have even given him pain meds because they would have had to transport him then and potentially end up stuck waiting in the ED with him, which takes them out of service for potentially life threatening calls...the "what ifs" are endless).
So thank you for your article and for reading this letter. I am deeply disturbed by the situation at St. Peter ED. I loved emergency nursing until it became such a horrible situation there. It was bad before Covid, actually, and Covid only made it worse. However, the problem is not Covid. The problem is multi-faceted. There are many things that the leadership of the ED could do to help, but ultimately Providence-Swedish leadership needs to wake up and stop ignoring the horrendous situation. I hate the fact that I can no longer feel safe telling friends and family to go the ER when they need to. Better pay, better working conditions for all of the nurses would help and ultimately, another hospital for our community is what is needed to improve this situation (CMC is tiny and inconsequential).
Wednesday, August 9, 2023 Report this
SecondOtter
A few years ago, I believed I was experiencing a heart attack. My spouse drove me to the ED at Providence. The ED was full of what I can only assume were homeless people. I spent the night there and not once did I see any of them being called for care. Most of them were sleeping, one was ranting about being cheated by his drug salesman. . As it was freeezing outside, I think the staff let them stay. ,
After several hours wait, I was finally put on an EKG and found my heart had restored it's normal rhythym. I was sent home.
And I got a bill for my care that charged medicare $4100...for a fifty second EKG. IT took longer to hook up the sensors than the test did.
OUTRAGEOUS.
Wednesday, August 9, 2023 Report this
Terrilovesanimals
WOW! Reading your ordeal and the other comments prompted me to tell my brief one. 3 years ago I went in at 12:30 am thinking my supplements and heart meds had lodged in my throat. I was there til 6 am before I got to see a doctor. They had to order something to numb my throat so they could use a probe to look down it. They got sore throat spray! WHAT?? The doctor kept trying as I was gagging and spitting the water up that I was drinking. I was sent home saying they couldn't find anything. 7 months went by with me having things catch in my throat. I went in for an MRI but could when they tried to get me into the unit I felt like knives jabbing me in my throat. I was sent to Capital ENT. They used the correct numbing agent and were able to probe. He told me they could not let me go home and I needed surgery. I got it at 7pm. A large sprung paperclip had gotten into my pill bottle and had clipped onto my epiglottis. It could have done so much to me if it had dislodged! I wrote to the CEO of St. Peters and they passed the letter to the ER department. Their response: We will use this as a learning experience. No apology, nothing else. They could have killed me! Sore throat spray? 7 hours?
Saturday, August 12, 2023 Report this
fuzzyland
This problem is much larger than Olympia and Providence, although Providence is certainly part of the problem. For a more global perspective please see this blog by and ER physician: https://www.kevinmd.com/2023/02/hospitals-at-a-breaking-point-lack-of-staff-and-resources-leave-ers-in-chaos.html
Sunday, August 13, 2023 Report this
MaryTippsSmith
My 73-year-old mother was here last month, visiting from Idaho. She became ill with heart attack symptoms and I called 911. The medics were AMAZING. After we arrived at Providence St. Peter's, I was shocked to find that they had to get her into a wheelchair and leave her in line to check in as though she had not been brought in by ambulance. After we got checked in, she was made to hang out in the waiting area, was triaged like a walk-in, and had to move into chairs to get her blood drawn and IV started. Throughout this, she was vomiting and in pain. She was not able to stand or walk unassisted. Finally she was taken back to a bed in the hallway. The IV hydration meant she needed to urinate and each time I was told to walk her to the bathroom myself. I am not a big woman and the whole time I was afraid she was going to fall. Finally a staff member offered to hook up a device that would allow her to simply urinate into a tube which would then funnel urine into a suction device, and into a bin. She agreed. Right there in the hallway without so much as a curtain, my sweet mother had to disrobe and have this device applied to her *****. She was in so much pain she didn't care, but for me the experience was just mind blowing. An old woman having to expose her genitals in a hallway. She ended up admitted but there were no rooms available so she was moved into a private room on one side of the ER. In the middle of the night, a room opened and she was moved. Her stay after that was great. But the emergency room experience - oh, my. I hope we never need that ER again. It's better than nothing, but WOW there is so much need for change - for more - more room, more staffing, more beds, more funding, MORE. This poor ER is not able to meet the needs of the community and is struggling really hard.
Monday, August 14, 2023 Report this
DevilsAdvocate
Without a doubt St. Peter Hospital, Providence need some change. Most healthcare systems do. That said, this article is misdirected ire. I'll make some points below:
1. Ambulances and EMTs are for life threatening emergencies. A doctor should know that. A dislocated elbow does not preclude one to walk. So just starting there, this is a classic misuse of the medical system that causes bottlenecks where there shouldn't be. How many people and ambulance vehicles does it take to get a young man with an elbow injury to the hospital?
2. The ER was a Zoo. Yup, that's what happens when people use the ER for common colds, minor sprains, med refills and other non life threatening emergencies. You get a zoo. The author should know this. So maybe Jolt and the author could use their position to do a weekly public service announcement informing the public of proper ER use. Do not expect the ER to drop the heart attack, stroke, respiratory patients to care for a non life threatening emergency.
3. The author mentions a freestanding ER in Texas was better, so let me unpack that for you:
a. You know what Texas has that Washington doesn't? Tort reform. The author mentions her son didn't get analgesics while waiting in the ER. In Texas they may have done this, mainly, because if the patient has a reaction to the medication while waiting outside a room, they can't sue the doctor and ER for everything they're worth. Imagine if this patient were administered an analgesic in the ER and he had a reaction to it, the author would be dragging the doctors, nurses and hospital for administering a medication without proper observation. And then would sue for as much as possible.
b. The ER in Texas is also PRIVATE. You know what that means? You have medicaid? Look elsewhere. Medicare? Let me check your supplemental. Uninsured? Ha! St. Peter is a safety net hospital that takes anyone, taking on the burden of low or no paying patients for the entire region. You can't compare a private ER that can pick and choose (and likely does) the best paying customers to a hospital that accepts everyone and then also eats the cost of caring for under or no pay patients.
c. The ER in Texas is standalone. This means that they don't have to worry about whether or not there are hundreds of patients admitted without anywhere to discharge them and therefore backlogging the ER severely. Also, Texas has a very high number of hospitals per capita, we don't. You're comparing apples to oranges.
4. Yes, again, St. Peter needs changes. But as I mentioned they are a safety net for the region and are the only ones! If the author and the readers want to change this here are some suggestions: 1. Demand that the other large medical groups that are in the area take their fair share of medicaid and uninsured patients, rather than just the high paying and well insured. 2. During then next elections, elect representatives that will enact medicare payment reform. When medicare cuts payments, especially to primary care, doctors won't take them and you end up with people not having primary care doctors and using the ER for this. You can't ask anyone to spend $1000 dollars taking care of a patient and pay them $700. Not a hospital, not a clinic, not a doctor or a nurse. Enact and demand reform from everyone instead of ranting against those who are trying their best to help.
Tuesday, August 15, 2023 Report this
Drutty
Thank you for your well written article and I too have had some loong waits in Emergency but found the staff trying to do their very best under extremely limited circumstances. I only hope that St. Pete's will contact you as your background makes you the perfect person to head an " Emergency Advisory Board" of 5 people (no tie votes) to help solve these blatant problems. I also think that Capital Medical Hospital should be given an ultimatum to become an emergency trauma center but it appears they do not want to spend the money!
Wednesday, August 16, 2023 Report this
DogTired
I spent the first 10 years of my career working in the ED. I still love Emergency nursing, but I will never go back to working in ANY ED. The wait times are not just a Providence problem, they are a nation wide problem. Do you really think going to Tacoma would have made the wait any shorter? Do you think they would have administered anything stronger than Tylenol while waiting to be seen? Guess again. I worked in both EDs while I was traveling and the wait times back then were long and people were placed on hallway beds. While a dislocated elbow is extremely painful unless the dislocation is causing lack of blood flow to the limb, it is not a life-threatening emergency. The ED is drastically understaff, as is the rest of the hospital. Administration is not doing what needs to be done to fix the problem. Even if they were, there are problems with the hiring system at Providence so good, qualified people that apply aren't receiving calls for interviews. As for stand alone EDs, I think they are great. I worked at one for 10 years and loved it. Unfortunately, they have a limited amount of space and most don't admit patients. Most can take care of major traumas and they certainly don't have cath labs or ORs, so again, they are sending people out for a higher level of care, which will probably mean going to the ED to wait either for an OR, or a room in the hospital. The community has outgrown St. Peter's. It is the only hospital to serve a 5 county area. Read that again, THE ONLY HOSPITAL TO SERVE A 5 COUNTY AREA. Prior administrators have advocated to have another tower built to increase beds and availability, but the state of Washington has denied the request stating there isn't a need. There was a need 10 years ago, and that need has only increased. If you want something done, then please go to the state and tell them your story. Telling your story here isn't going to make anything happen unless you give it to the ones that actually have the power to make the needed changes.
Thursday, August 17, 2023 Report this
longtimeresident
I am just now seeing these comments, but had a similar experience as described by many others in this comments section. I was at St. Pete's ER on July 26, and subsequently wrote up my observations and posted them on Nextdoor. I got 191 comments and 12,400 views. My question now is: Is the administration at St. Pete's doing anything of significance to make changes to the ER experience at their hospital, and if not, why not.
Wednesday, November 15, 2023 Report this
Bekindtoeveryone
This is just the tip of the iceberg. So many stories need to be told. Dr. Debra, I sent you an email.
Thursday, November 16, 2023 Report this