Hospital Capacity

Emergency Department and hospital volumes

• Patient volumes in the Emergency Department (ED) are typical for summer; we continue to experience surges and high patient acuity in the ED.
• Hospital census was higher this summer than in typical summers pre-pandemic. Significant planning is occurring to prepare for the fall/winter surge.

COVID-19

• We are beginning to see increased SARS-CoV2 activity as our testing positivity is increasing; we expect rates to further rise with the start of school.

Chemotherapy drug supply

• The national shortage of chemotherapy drugs continues.
• We continue to monitor our supply closely and work with our distributors to ensure we have adequate quantities including methotrexate.
• We are coordinating our efforts regionally and nationally to look for long term solutions to ongoing medication shortages that impact patient care.

Emergency Department volumes

A new space opened in the hospital in July to help care for Emergency Department (ED) patients with mental health concerns. The ED still has capacity constraints, especially in the evenings secondary to patient surges and patients who remain in the ED awaiting final disposition. Effective July 18, Seattle Children’s deactivated the code yellow for the surge in youth mental health patients and the Emergency Department (ED). Seattle Children’s continues to update our policies and improve workflows to support mental health patients experiencing extended lengths of stay due to barriers to discharge.

Please continue to call the Mission Control team at 206-987-8899 when sending a patient to the Seattle Children’s ED.

Chemotherapy drug shortages

A nationwide shortage of certain chemotherapy drugs is impacting many hospitals, including Seattle Children’s. It is not yet known when supply will improve. Some of our patients may require changes to their treatment; our care teams are working hard to limit negative impacts. We are working with multiple distributors to secure as much medication as possible. Read full post »

Since our last update in early June, the Emergency Department (ED) is still over 100% capacity many evenings but has seen some decrease in wait times.  We continue to see many patients presenting for mental health assessment and are still requiring a significant number of those patients to wait more than 24 hours for the next step in care, which may be an inpatient bed in our Psychiatry and Behavioral Medicine Unit (PBMU), a transfer to an outside facility or a safe discharge plan.  As always, please do not hesitate to send patients to the ED when you have emergent concerns.

Overall inpatient census has improved.

We continue to monitor the situation and employ our internal Emergency Operations Center to ensure systemwide coordination to address capacity constraints.

How you can help:

• Please continue to identify and manage lower-acuity complaints in outpatient settings to help maintain our limited capacity in the ED for higher-acuity concerns.
• Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. Your early call allows the necessary time to plan for your patient’s arrival, and, in appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.

As a reminder: Patients experiencing an emergency should come to the ED (or go to their local ED) without hesitation.

Resources that may help you manage patients in primary or urgent care instead of sending to the ED: Read full post »

As noted in recent Provider News updates, our Emergency Department (ED) continues to experience high patient volumes and high patient acuity due in large part to the ongoing youth mental health crisis.

A significant number of patients presenting with mental health concerns are having to wait more than 24 hours in the ED for the next step in care, which may be an inpatient bed in our Psychiatry and Behavioral Medicine Unit (PBMU), a transfer to an outside facility or a discharge plan.

Actions We Are Taking

We have been working closely with state partners seeking additional flexibilities in caring for patients presenting with mental health concerns, and the state recently granted those flexibilities.

Meanwhile, Seattle Children’s has reactivated our internal Emergency Operations Center to ensure systemwide coordination as our leaders and teams address the ED challenges with multiple simultaneous approaches.

We would like to once again offer these reminders:

1. Patients experiencing an emergency should come to the ED (or go to their local ED) without hesitation.
2. The PBMU currently has limited capacity due to ongoing facility improvements for patient safety. Patients who require a psychiatric inpatient admission will be referred to all appropriate inpatient pediatric psychiatric facilities in Washington state. 
3. Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. Your early call allows the necessary time to plan for your patient’s arrival, and, in appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.
4. Please continue to identify and manage lower-acuity complaints in outpatient settings to help maintain our limited capacity in the ED for higher-acuity concerns.

Resources for Providers

Resources that may help you manage patients in primary or urgent care instead of sending to the ED: Read full post »

From: Dr. Jeff Ojemann, SVP and Chief Medical Officer, Dr. Ruth McDonald, VP and Associate Chief Medical Officer (Hospital Operations) and Dr. Tony Woodward, ED Medical Director

The ongoing youth mental health crisis is contributing to high patient volumes, high patient acuity and significant boarding in our Emergency Department (ED).

1. Patients experiencing an emergency should come to the ED without hesitation.
2. We have re-activated an Emergency Operations Center to ensure systemwide coordination as our leaders and teams address extreme capacity constraints in the ED with multiple, simultaneous approaches.
3. The Psychiatry and Behavioral Medicine Unit (PBMU) currently has limited capacity due to ongoing facility improvements for patient safety. Patients who require a psychiatric inpatient admission will be referred to all appropriate inpatient pediatric psychiatric facilities in Washington State. 
4. Please continue to identify and manage lower acuity complaints in outpatient settings to help maintain our limited capacity in the ED for higher acuity concerns.
5. When sending your patient to the ED, please contact our Mission Control team at 206-987-8899 and alert families to potentially expect longer-than-normal wait times.

For More Information:  Resources that may help providers manage patients in primary or urgent care instead of sending to the ED:

1. Emergency or Urgent Care Referral Guide
2. For urgent medical care not related to mental and behavioral health, remind families to schedule an in-person or virtual Urgent Care appointment as early as possible to help them get timely access. They can use the UC online scheduling system or call the hospital’s main number at 206-987-2000.
3. Algorithms and other PCP resources for 65+ conditions
4. The Partnership Access Line (PAL) supports primary care providers (doctors, nurse practitioners and physician assistants) with questions about mental health care such as diagnostic clarification, medication adjustment or treatment planning. Our child and adolescent psychiatrists are available to consult during business hours.
5. The Washington Mental Health Referral Service connects patients and families with evidence-supported outpatient mental health services in their community. This free, telephone-based referral service provides thorough mental health referrals for children and teens 17 and younger from across Washington.
6. First Approach Skills Training (FAST) programs are designed to provide brief, evidence-based behavioral therapy for youth and families with common mental health concerns, in settings such as primary care clinics or schools where longer-term treatment is not typically provided. Program materials, as well as engagement and assessment tools for Mental Health Clinicians are available on the FAST Website.
7. Seattle Children’s online mental health hub: provides resources for families and caregivers to reference for their child’s mental health and wellness. You can learn about common mental health problems in children and teens, how to recognize the signs of a problem and crisis, and learn how to help your child or teen as well as what services are available.
8. Family Resource Center – Child Mind Institute: provides information families and caregivers to help support children who are struggling with mental health, behavior or learning challenges.
9. Strategies for Clinical Settings for Youth Suicide Prevention (aap.org): provides a clinical pathway for addressing suicide prevention in pediatric practice.
10. Mental Health Practice Tools and Resources (aap.org): provides resources to help providers promote healthy mental development and address mental health concerns.

From: Dr. Jeff Ojemann, SVP and Chief Medical Officer, Dr. Ruth McDonald, VP and Associate Chief Medical Officer (Hospital Operations) and Dr. Tony Woodward, ED Medical Director

Measles infection

We want to let you know that a pediatric patient who has tested positive for measles is receiving treatment at Seattle Children’s. The hospital was made aware before the patient arrived. Upon the patient’s arrival on Thursday, May 18, staff and faculty members immediately implemented appropriate infection control procedures, which included isolating the patient and reporting the case to public health authorities. No workforce members or other patient families at Seattle Children’s were exposed.

Seattle and King County public health officials are looking into the source and any potential spread of the measles case. You can find further details in a Seattle Times article here.

Reminders for healthcare providers:

• Isolation is the key to preventing transmission of measles infection. If a patient or family has a fever and rash, isolate them right away using appropriate personal protective equipment.
• Remind any patients and families with a fever or rash to NOT show up unannounced at their local healthcare provider or Seattle Children’s. If sending a patient to Seattle Children’s with measles symptoms please be sure to coordinate with our Mission Control Center in advance at 206-987-8899.

Emergency Department Continues to Experience Extremely High Volumes

Seattle Children’s Emergency Department (ED) is operating under extreme constraints with high acuity patient demand and significant boarding. Our leadership and teams are addressing these constraints with multiple, simultaneous approaches.

To help ensure we are able to provide timely, safe care to patients in the ED:

• We ask for your continued support in managing patients in primary care whenever possible and appropriate. This will help the hospital maintain the capacity to care for the sickest patients.
• When sending families to the ED, please call our Mission Control team first (206-987-8899) to help us with staffing and space planning. Advise families to expect longer-than-typical wait times and that we are triaging to see the sickest patients first.

We want to recognize the extraordinary efforts of our provider colleagues in supporting ED care over the last several years, and thank you for your continued partnership.

High volumes hospital-wide including the Emergency Department and PBMU

We are experiencing persistently high demand for medical and surgical services, with acute care beds 90% full if not higher.

The Emergency Department (ED) continues to see record high demand in the setting of a significant increase in mental health boarding. Given the resultant ED physical bed capacity constraints, patients will likely experience longer wait times. The ED remains available for all emergent patients and will continue to prioritize the sickest patients. If patients are non-emergent, please use non-ED alternatives for care whenever possible. When sending patients to the ED, please call ahead to our Mission Control center to alert us. Calling is essential to helping the ED anticipate needs. Please thank families for their patience as we balance all the needs of the community at this time.

Capacity in the Psychiatry and Behavioral Medicine Unit (PBMU) continues to be constrained, with limited ability to accept referrals from other hospitals, due to ongoing facility improvements in the PBMU that are intended to open up more capacity over the long-term for these services.

Read full post »

Updated Masking Policy

Seattle Children’s is continuing to require masking in all clinical areas and public-facing areas of the hospital and our clinics, following the April 3 conclusion of Washington state’s order requiring universal masking in healthcare facilities. Seattle Children’s, along with many of our healthcare peers, signed onto a letter from the Northwest Healthcare Response Network in support of continued masking.  Seattle Children’s masking requirement applies to patients, families, visitors and workforce members. Masking will be optional in Seattle Children’s nonclinical buildings and non-public-facing areas of our clinical buildings.

Our visitor policies were updated effective April 3 to allow more visitors at the bedside. Details are available on our website.

Code Yellow Deactivated

Seattle Children’s deactivated its Code Yellow for high census and hospital capacity constraints, effective March 15, 2023. This is the first time in years that Seattle Children’s is not in active Code Yellow.

Very High Patient Volumes in the ED

Despite having little to no RSV/flu activity, the Emergency Department (ED) continues to see high patient volumes and broke previous all-time records for March.  We are continuing to see very high mental/behavioral health volumes in the ED. We also continue to experience fluctuations in inpatient census. We are using the processes and operational improvements established during the Code Yellow period to manage patient flows.

ED Communication Center Is Now Part of Mission Control

Seattle Children’s recently formed a new Mission Control office that brings together multiple teams, including the former ED Communication Center, to improve and streamline our processes for patient admissions, discharges and transfers.

When sending patients to the ED or requesting direct admission to the hospital, please continue to call first: 206-987-8899 (formerly the ED Communication Center; now Mission Control). Your call will help us anticipate staffing needs and plan for your patient’s arrival.

Hospital capacity

Seattle Children’s is beginning to experience some relief from the extremely high capacity constraints of recent months. We do, however, continue to see high winter volumes.

• Overall hospital census remains high, and the Emergency Department (ED) is still seeing extremely high patient volumes.
• The wave of patients experiencing mental and behavioral health crises is not slowing down.
• Seattle Children’s remains in active Code Yellow status, although at a lower level of response; we continue to monitor the situation and enact solutions to address the challenges we are facing.

Other important updates from Seattle Children’s

• Synagis season has ended: Due to exponential declines in RSV rates and related admissions, Seattle Children’s is no longer administering Synagis prophylaxis as of Tuesday, February 28. For more information, please consult state-specific recommendations for patients outside of our local area and review WA state and other data from the CDC.
• We have a scheduling backlog; please encourage families to proactively call us to schedule. We are hiring additional scheduling staff to keep pace with high demand but our pace of calling out to families to schedule is slower than we’d like. In some cases, patients may get an appointment several weeks sooner if they proactively call us to schedule instead of waiting for one of our schedulers to call them.
• GI has high referral volumes and long wait times; please manage constipation in primary care whenever possible.
  • Non-urgent general GI referrals without red flags, including constipation, are currently scheduling 3 to 5 months out.
  • GI has approximately 3,000 referrals in their scheduling queue with limited slots immediately available.
  • GI is still accepting constipation referrals but encourages PCPs to see these patients in primary care whenever possible to ensure timely care. This will also help Seattle Children’s maintain good access for patients who most need specialty care.
  • Our GI Refer a Patient webpage offers many PCP resources including:
    • Functional Constipation Clinical Protocol (PDF), developed by Seattle Children’s specialists in collaboration with community providers, can help you determine whether your patient should be referred to a specialist or treated in primary care.
    • Algorithm for Functional Constipation (p. 12 in document above)
    • Guideline for families, including education materials to help understand and manage their child’s constipation
    • Polyethylene Glycol (MiraLAX) Dosage Table
    • Severe or Chronic Constipation: Polyethylene Glycol (MiraLAX) Dosage Table
    • Chronic Constipation Treatment 3-Day Cleanout and Maintenance Dosing Tables
    • Bowel Cleanout and Maintenance Program at a Glance

Seattle Children’s new hospital wing, Forest B, opened 20 new surgical inpatient rooms on the 8th floor, bringing the total number of surgical inpatient beds at Seattle Children’s to 94 — a 27% increase.

The new inpatient rooms are single-occupant and primarily serve patients who are recovering from general surgery and urology procedures. The inpatient unit includes a lounge and kitchen for family use.

Forest B was completed in summer 2022 and has been opening in waves, with eight new operating rooms and two catheterization labs opening last October followed by the opening in December of the new outpatient space for the Cancer and Blood Disorders Center. Forest B sits adjacent to the Emergency Department and serves as the hospital’s new “front door.” Learn more.