OHSU’s and Legacy Emanuel’s children’s hospitals implement crisis care standards

Oregon’s only two hospitals with intensive care units for children have moved to crisis standards of care, the latest step by the state’s health care system to battle an influx of respiratory disease cases among children.

The crisis standards, developed by the Oregon Health Authority, help hospitals decide which patients get care when resources are severely limited, and allow them to loosen staffing standards so that nurses can care for more patients.

The primary culprit sending infants and children to the hospital is RSV, or respiratory syncytial virus. The virus is particularly dangerous for infants and the number of children hospitalized with it has grown dramatically in recent weeks. The influx of patients combined with ongoing staffing shortages have severely strained hospitals.

The two hospitals, Doernbecher Children’s Hospital at Oregon Health & Science University and Randall Children’s Hospital at Legacy Emanuel, account for most of the state’s pediatric intensive care unit beds. The hospitals have a combined capacity of 44 beds, but the actual number of staffed beds fluctuates. Providence St. Vincent has an additional four pediatric intensive care beds and can expand to six if necessary, a Providence spokesperson said.

As of Nov. 16, there were a total of 40 staffed pediatric intensive care units statewide, an Oregon Health Authority spokesperson said, of which three were available.

In announcing their decision Tuesday, Randall Children’s Hospital said it was postponing non-urgent pediatric procedures, is asking staff to work extra shifts and is using “creative staffing options” to provide care. A spokesperson for the Legacy Health did not say how many of its pediatric intensive care beds are available.

“This has been an unprecedented respiratory viral season, both in the timing and the number of children affected,” Randall Children’s Hospital Vice President and Chief Nursing Officer Cindy Hill said in a statement announcing the transition. “We are implementing safe solutions to meet community demand for pediatric beds.”

Doernbecher activated crisis standards 7 p.m. Monday. An OHSU spokesperson said its pediatric intensive care unit was “at capacity.” The hospital is not yet triaging care, but it is using crisis standards to more effectively allocate its resources.

Under standards the state issued by the state in January of this year, hospitals can switch to crisis standards of care if their “critical care resources are severely limited, the number of patients presenting for critical care exceeds capacity, and there is no option to transfer patients to other critical care facilities.”

The hospitals’ steps come amid a declared state of emergency, issued by Gov. Kate Brown Nov. 14. The declaration could free up resources for hospitals and give them more flexibility in staffing hospital beds. A recent OHSU forecast predicts RSV hospitalizations will peak Nov. 30, at 129 admissions, up from 77 the week ending Nov. 9.

— Fedor Zarkhin

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