Inside an intensive care unit: Largest local hospital braces as COVID-19 hospitalizations rise
Certified Nursing Assistant Katy Griffin, wearing a gown and various other personal protective equipment, motions to another nurse from inside of one of the Intensive Care Unit's negative pressure rooms inside Samaritan Hospital.
Emry Dinman/Columbia Basin Herald
Various medical devices used to monitor a patient's vitals and to delivery oxygen line the wall next to an occupied bed at Samaritan Hospital's Intensive Care Unit.
Nurses Christine Lowen, left, and Mandy Moncada, right, take a look at a computer screen inside the Intensive Care Unit. Around the main desk, 12 fully-enclosed, negative-pressure rooms each house a patient that can be monitored from this desk. Despite the pressure of a full ICU, there are also a thousand little reminders of Christmas throughout the hospital, such as these gingerbread houses.
Maintenance worker Viktor Kvitovskiy holds a piece of tissue paper in his left hand that he runs along the edge of the ICU's 12 rooms, checking to make sure the negative pressure rooms are working properly and that there is no airflow from the rooms inside of the ICU office.
Sandy Martin, a registered nurse that works in Samaritan Hospital's ICU, gears up before going into one of the negative pressure rooms. Martin has worked in healthcare for 45 years and is one of Samaritan's most experienced veterans.
MOSES LAKE — Nine months into a global pandemic, Samaritan Hospital is facing possibly the largest surge of coronavirus hospitalizations and juggling patients with other crowded hospitals.
As medical workers brace for a potential hospital capacity crisis that many feared back in March, the Columbia Basin Herald and other media were allowed into the hospital’s ICU for the first time since the pandemic began.
Though the health care provider still has some buffer before it would have to activate its surge plan, which would convert much of the hospital to maximize inpatient bed space in the worst-case scenario, the 12-bed ICU is now full more often than not, said Julie Nishida, a registered nurse and house supervisor at the hospital.
“Even though this is our typical, busy month — in previous years it would have been flu and RSV season — that’s typically when we would see 12 patients in the unit, but now it’s pretty much 12 patients most of the time. We’re needing more staff all of the time,” Nishida said Friday.
That doesn’t mean if another person needed an ICU bed they would be turned away. In those situations, Nishida said, the hospital has checked to see if a patient already in the ICU is ready to be transferred down to the medical/surgical unit or discharged altogether. For months, the hospital has also worked with other health care providers in the region to transfer patients that require a more acute level of care to hospitals that can provide that service, often in exchange for a less acute patient.
“We have a fair amount of movement that happens between everything from the critical access hospital to the tertiary care centers in Spokane,” said Dr. Andrea Carter, chief medical officer at Samaritan. “We might accept a patient from Central Washington Hospital (in Wenatchee), which might seem backward, but the tradeoff is that they would take one of our higher-level patients.”
While Samaritan is equipped to handle patients suffering from respiratory failure, a typical acute symptom of severe coronavirus infection, patients with additional comorbidities or experiencing multi-system failure, such as kidney or heart failure, may need to be transferred, Nishida said.
But as hospitals throughout the state and region experience a sharp rise in coronavirus hospitalizations, those transfers have become more difficult to organize, Carter said.
“It’s hard. The hospitals we typically send people to, they’re full as well,” Carter said. “Same issues: beds and staffing. We have sent people to Seattle before because there was a lack of beds at the right level in Eastern Washington.”
Samaritan, along with other hospitals in the state, have surge plans in place should they become necessary. Though Samaritan is licensed to house 50 inpatients, the state at the start of the pandemic required the organization to create a contingency plan to house up to 200.
Now, Samaritan has a plan to convert everything from office space and recovery areas in the operating rooms into bed space should the surge plan be activated. Those plans would be activated if the hospital reached 44 beds filled overall or 29 filled with coronavirus cases, Carter said. As of Friday morning, 30 beds were filled, of which 14 were coronavirus patients. In recent weeks, the hospital saw 18 coronavirus-positive patients at once, the highest yet.
But a surge in hospital beds won’t be sufficient without trained medical workers to staff them, and staffing at hospitals can already be difficult at times, Nishida said. The ICU requires more staffing than normal, and though staff infections have been lower than was feared, staff in the ICU, Medical/Surgical Unit, and Mother-Baby Unit have been infected with the coronavirus at one time or another. More staff have also had to quarantine because they came into contact with someone who was infected or because they had unrelated sniffles.
“Now you can’t have the common cold, because it might be COVID,” Nishida said. “So now it’s just continually watching signs and symptoms, getting tested and getting cleared so you can go back to work.”
Some things have improved since the pandemic began, however, including patient outcomes and treatment plans, Nishida added. Medical workers aren’t as quick to intubate -- placing a tube through the mouth and into the airway — patients as they were in the beginning due to the damage it can cause. The technique is now considered more of a last resort.
As more has been learned about the long-term effects of severe coronavirus infection, health care workers have also learned to send patients home with medications to help tamp down on those symptoms, such as anticoagulants to help prevent blood clots, Nishida added.
“We know exactly what to do now,” Nishida said. “I feel like people are going through and they’re surviving.”
The Columbia Basin Herald also spoke with other nurses in Samaritan’s Intensive Care Unit, as well as the Respiratory Virus Evaluation Center. One nurse, who has worked in health care for almost half a century, and another, who recently graduated from Big Bend Community College, will explain how they’re feeling nine months into the pandemic. That story will appear in Tuesday’s edition.
