More patients, smaller staff challenge for Samaritan ER

MOSES LAKE — More patients, fewer staff, more paperwork and cramped spaces have combined to put strains on the emergency department at Samaritan Hospital. Matthew Lockwood, the physician in charge of the department, detailed some of the challenges in a presentation to Samaritan Healthcare commissioners Tuesday.

“If you have been there, you know that we’re small,” Lockwood said.

The ER has nine treatment rooms, Lockwood explained, all of which are traditional hospital rooms with beds and a door that closes for patient privacy.

“We have two (additional) rooms that we call flex care rooms. The rooms also have doors, they’re private, but they’re small. They have a recliner so that we can get patients who aren’t maybe quite as sick into that room, get them treated and discharged and get the next patients as quickly as possible,” he said.

The hospital also has four hall beds, which Lockwood said he’d rather the hospital didn’t need.

“I’m ashamed to say we have four hall beds, which unfortunately often have to be utilized,” he said. “Nobody likes hall beds – there is no privacy; very often there’s not a comfortable place for a family member to sit. It’s not a pleasant experience with patients. We regret having to put patients in these hall beds, but if we didn’t use these hall beds we couldn’t take care of a lot of patients.”

Samaritan Chief Executive Officer Theresa Sullivan said the ER had about 24,000 visits in 2022.

“The American College of Emergency Services says that for an emergency department that has 20,000 visits, we should have 15 rooms,” Sullivan said.

The flex care rooms were added in 2016, but other than that the ER hasn’t been remodeled since 1975, she said. That was nearly 50 years ago.

Lockwood said the shortage of medical professionals, not only in Washington but nationwide, means there are fewer doctors, nurses, nurse practitioners and physician assistants taking training for emergency medicine. There’s also a shortage of family practice medical professionals. That lack of family doctors causes problems in the ER.

“So if you get sick and you call your primary care doctor, they may say, ‘We can get you in next month,’” Lockwood said. “That’s not going to help you very much. So those patients are either going to the walk-in clinic or the emergency room.”

When the ER is busy, medical professionals will do what they have to do, Lockwood said.

“When it gets backed up, it’s not uncommon to see one of us kneeling down next to a patient in the waiting room and talking to them very quietly in their ear, to figure out how we can get things started,” Lockwood said. “We hate to do that. Again, we’d like a lot of privacy here, but if it needs to be done to see that patient sooner – that’s what we’re going to do.”

Samaritan also is experiencing an increase in the number of psychiatric patients visiting the emergency room, he said. Psychiatric patients typically need more supervision. The shortage of qualified personnel, not only doctors and nurses but all staff, means that some patients can’t be transferred, sometimes for days, and have to stay at Samaritan, sometimes in the ER.

Regulations covering some medical records were changed in January, he said, and facilities are having to adjust, a process that takes up time when departments are understaffed.

Expansion on the current site would be difficult if not impossible, Lockwood said in a later interview. The ER is on the southeast corner of the building, with embankments on two sides. Samaritan officials have looked for additional space inside the hospital, and temporarily have used rooms directly behind the ER, as well as cots in hallways during a surge in the COVID-19 pandemic. But converting sections of the first floor isn’t really feasible, he said.

“We cannot expand to any adjacent areas,” Lockwood said. “There’s really no place to do that.”

Lockwood said hospital officials are working with other facilities to expedite patient transfers. Ultimately, however, the ER needs more room, he said.

“I think stopgap measures will only get us so far before we hit a hard stop in improving patient care,” he said.

Cheryl Schweizer can be reached at education@columbiabasinherald.com.