Hospital Capacity

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.

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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.

Hospital capacity in Washington State

• The Washington Medical Control Center (WMCC) is reporting a decrease in calls after their record numbers in December. WMCC is the regional transfer center developed during COVID-19 to ensure statewide situational awareness and to balance patient distribution across the state.
• Hospitals across the state continue to report heavy adult ED boarding and most large hospital systems still have a census above 100%.
• SARS-CoV2 is rising nationally and another surge is expected but we are not seeing significant rises in adult or pediatric hospitalizations for COVID-19 at this time.
• The large pediatric patient surge we experienced in November has improved over the last two months.  There have not been any pediatric transfers that required WMCC since January 13.

Capacity at Seattle Children’s

• The Emergency Department (ED) is seeing lower volumes than the record numbers of patients seen in November and is back to regular high winter volumes.   We continue to have high mental health boarding in the ED with high acuity with occasional longer waiting times.
• Seattle Children’s inpatient census has remained above our historical baseline with high patient acuity and technological needs.
• We are monitoring viral curves closely for RSV/influenza/other viruses.  We have seen a downward trend overall but will know more in the next few weeks.  We have not seen Influenza B yet but it generally follows Influenza A in late winter or early spring.
• We are going live this week with a new post-procedural short stay unit to increase operative capacity that does not impact inpatient bed spaces.

When sending patients to the ED

• Our ED is open and ready to care for your patients; please do not hesitate to send patients when the ED is the appropriate setting for care.
• When sending patients to the ED, please call our ED Communications Center at 206-987-8899 to help us plan for their arrival.
• Let families know they may experience longer waits for non-critical issues and that we continue to triage to identify and see the most emergent patients first.

We continue to be deeply grateful to our colleagues in the community who are working relentlessly to care for pediatric patients in primary care and preserve capacity in hospitals and urgent cares for those patients who need it most.  Thank you!

For more information:

• Respiratory Viral Epidemiology Data | UW Virology (washington.edu)
• Washington State Influenza Update (Washington State Department of Health)
• Emergency or Urgent Care Referral Guide (seattlechildrens.org)
• What Parents Should Know About RSV (seattlechildrens.org)

Pediatric hospitalization in WA

• The Washington Medical Control Center (WMCC) is the regional transfer center developed during COVID-19 to ensure statewide situational awareness and to balance patient distribution across the state.  They reported that in December they had the highest numbers of calls ever in the pandemic.  This is indicative of the immense strain on the hospital system.
• The large pediatric surge we experienced in November improved in December as WMCC reported fewer requests for assistance for pediatric transfers.

Capacity at Seattle Children’s

• The Emergency Department (ED) is seeing lower volumes than the record numbers of patients seen in November. We anticipate those numbers rising as people return from holiday travel and start back to school.  We continue to have high mental health boarding in the ED with high acuity.
• Seattle Children’s maintained high inpatient census with increased staffing challenges through the holidays.  We also have had very high acuity and high technology needs in the ICUs that challenged our ability to accommodate all surgical cases and transfers.  We anticipate staffing challenges to improve over the next couple weeks.
• We are monitoring viral curves closely for RSV/influenza/other viruses.  We have seen a downward trend overall but will know more in the next few weeks.  We have not yet seen Influenza B but expect it will show up at some point.
• SARS-CoV 2 is rising regionally and nationally as the Omicron variant XXB.1.5 becomes the dominant strain.  We are monitoring this rise closely and are currently unsure of the impact on pediatric patients.
• Capacity in the Psychiatry and Behavioral Medicine Unit (PBMU) will be limited in 2023 due to two important initiatives that will provide improved care and capacity in the long-term: staff training to support a new model of care and replacement of the fire alarm system. We recognize any bed reductions in the PBMU will affect other departments, especially the ED. We are working to identify options for increased capacity for boarding ED mental health patients and are watching patient volumes closely to determine the safest options for care.

When sending patients to the ED

• Our ED is open and ready to care for your patients; please do not hesitate to send patients when the ED is the appropriate setting for care.
• When sending patients to the ED, please call our ED Communications Center at 206-987-8899 to help us plan for their arrival.
• Let families know they may experience longer waits for non-critical issues and that we continue to triage to identify and see the most emergent patients first.

We continue to be deeply grateful to our colleagues in the community who are working relentlessly to care for pediatric patients in primary care and preserve capacity in hospitals and urgent cares for those patients who need it most.  Thank you!

For more information:

• Respiratory Viral Epidemiology Data | UW Virology (washington.edu)
• Washington State Influenza Update (Washington State Department of Health)
• Emergency or Urgent Care Referral Guide (seattlechildrens.org)
• What Parents Should Know About RSV (seattlechildrens.org)

Unprecedented ED Patient Volumes and Inpatient Census

• Seattle Children’s Emergency Department is open and ready to care for all children needing emergency care. Do not hesitate to direct patients to the ED if they need immediate medical attention.
• We continue to see very high levels of inpatient census and ED visits in the wake of unprecedented mid-September volumes, driven primarily by non-COVID-19 respiratory and gastrointestinal illnesses.
• We continue to run under a disaster incident command structure and contingency status for staffing and space.
• We ask that providers continue to manage patients in primary care whenever possible and appropriate.
• When sending families to the ED, please call our Communications Center first (206-987-8899) to help us with staffing and space planning.
• Please advise families to expect longer-than-typical wait times at our ED and that we are triaging to see the sickest patients first.

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