On an October day in 2022, Kelsay Irby, BSN, RN, then nurse at Silverdale, Wash.-based St. Michael Medical Center, called 911 for backup when the emergency department became overwhelmed with patient boarding. Now, after hospital leaders spent time crafting a plan for resilience, the hospital has shared the strategies that helped it turn things around.
"We're drowning," Ms. Irby said multiple times during the call to emergency dispatchers, according to the Kitsap Sun. "We're in dire straits, we need the fire department's help, can somebody come up here and help us?"
Ms. Irby, now employed by the Olympic Ambulance Service, has since stated that she "called 911 to ask for help in our overwhelmed ER during a cyberattack that took down all our electronic resources."
"The initial story wasn't quite relayed correctly, but the resulting discussions were, I hope, valuable in ways that are still being played out," she wrote. "In that moment, I wasn't thinking about thinking outside the box, or creating new possibilities. I was literally grasping at straws and trying to address a circumstance in which I saw no known solutions or remedies."
Following the incident, the interim emergency department head left his role at St. Michael's, the hospital faced recruitment challenges, received preliminary denial from The Joint Commission for accreditation before regaining it, and did not regain CMS compliance until May 2023.
Responding, resilience, and reintegration
The incident drew national attention to the hospital in the tiny 1,276 person town of Silverdale, but few stories following the aftermath recounted the detailed, behind-the-scenes work that teams at St. Michael's were doing to make sure something like this wouldn't happen again.
"Resilience is fundamental to work in critical care…" a team of subject matter experts who are closest to the hospital's response explained to Becker's via email. "Instilling and renewing resilience is a continual process, and we have found the best practices and activities come from the teams on the ground."
To turn things around, the hospital worked with the community to create an EMS Task Force comprised of members from St. Michael Medical Center, Kitsap County Emergency Medical Services and Trauma Council to identify gaps, issues, and propose solutions. The additional communication and collaboration with the task force has helped it decrease emergency room wait times and expand access to care.
The task force recommended three key things:
- Co-locating a triage nurse at the registration desk to be able to quickly evaluate patients based on their acuity.
- Streamlining processes and workflows to improve efficiency by creating a "moving waiting room" to provide care to lower acuity patients more quickly.
- Expanding data sharing across organizations, to provide transparency into pre-hospital and in-hospital processes.
Not only did the task force implement these recommendations after they were proposed, they seemed to help tremendously, the St. Michael's experts told Becker's.
"As a result of these efforts, the hospital decreased emergency department wait times and has maintained these improvements," they said. "Weekly median arrival-to-triage time has decreased from 15 minutes in December 2022, to two minutes or less as of June 2023. Patients who previously experienced a wait of two to three hours were seen and able to return home within 25–30 minutes."
It has also worked to expand care and properly refer lower acuity patients to various places for the care they need to keep them out of the emergency department, if possible. The team also now partners with the local fire department to identify when a patient may not need an ED visit, but just a primary care appointment or virtual visit instead. In those instances, EMS teams now call in a mobile advanced practice physician, who can see patients almost instantly using virtual urgent care or the patient can be scheduled for a same-day appointment.
While ED boarding and capacity issues continue to strain hospitals nationwide, St. Michael's says it is still refining things itself amidst the growing demand for care during a shortage of nurses and physicians taking place across the U.S. But, in 2023 alone, St. Michael's hired more than 100 additional RNs and saw its nurse retention rate increase 10% year over year.
"We have put emphasis on leadership development, improving communication and supporting rewards and recognition for the people on the frontline," they said. "We are committed to supporting our front lines while providing high-quality care to our community."