EvergreenHealth Monroe critical care unit has been closed

MONROE — Citing staffing shortages and community usage data, EvergreenHealth Monroe closed its critical care unit (CCU) on June 4.

And for east Snohomish County communities that rely on EvergreenHealth as a lifeline, the hospital’s move is a significant decision many are unaware of.

Over the past year, a group of administrative and clinical leaders have evaluated the CCU in terms of community need, financial performance and the ability to adequately staff the unit with current patient volumes, EvergreenHealth Monroe said in a statement.

“What’s most important for the community to know is that EvergreenHealth Monroe continues to provide access to high-quality care and service without disruption to our patients and their families,” the hospital said in the statement.

However, when patients need critical care that can not be achieved at EvergreenHealth Monroe due to the closure, they must be transferred to another hospital in the region where beds and critical care providers are available.

Transferring patients

While EvergreenHealth Monroe has had to transfer patients occasionally in the past, the four-bed unit was there to serve critical care patients. Now transfers are increasing, and emergency room nurses like Lauren Jensen are concerned about their ability to provide the care patients need.

The loss of four beds may not seem like a lot, but it is a substantial number in the larger scheme of things, Jensen said.

Patients waiting to be transferred to a CCU elsewhere must be treated in the EvergreenHealth Monroe ER, causing longer wait times for other ER patients who are also seeking treatment.

“In our ER we have 14 beds,” Jensen said. “It’s not a lot of beds if you have one or two critical patients that are there for a possible two or three extra hours because they can’t be admitted to the CCU.”

The Monroe hospital is one of four acute-care hospitals in Snohomish County. It was the only CCU serving east Snohomish County towns such as Sultan and Gold Bar.

Transferred patients will continue to receive care from physicians at the newly opened intensive care unit at the EvergreenHealth Kirkland campus, the hospital’s statement said.

The hospital is trying to streamline the transfer process as many patients have had to be moved, Dr. Ashley Tran Morin said in an Alliance Governance Board meeting on Aug. 4.

“It’s been extraordinarily difficult to find beds for these patients,” Tran Morin said during the meeting. “We call seven, eight hospitals in the area and no one has beds. It’s very challenging.”

From CCU to PCU

In place of the CCU, the hospital will be adopting a four-bed progressive care unit (PCU) model.

PCUs have been adopted widely as a cost-effective way of bridging the gap between ICUs and medical-surgical units. Essentially, a PCU is an intermediate level of care.

The hospital will “continually re-evaluate the PCU census and patient volumes to ensure we continue to meet the care and service needs of our community” and reassess the need for a CCU over the next six months, the hospital said.

Dwindling finances, shrinking workforce

EvergreenHealth Monroe is one of the many hospitals around the state and nation facing financial hardships as the pandemic takes a toll — seeing increasing expenses for protective equipment and postponing procedures such as elective surgeries that are relied on as moneymakers.

The hospital’s revenue was down $5 million just halfway into 2020. Money from the federal CARES Act, including PPP loans, has helped offset some of the losses.

Hospital leaders around the nation have cited nursing shortages as barriers to recruiting hospital staff, but health care workers say that’s not the full story.

A vicious cycle is taking hold as nurses and other health care workers leave unsatisfactory work environments, creating further staffing issues and causing more workers to leave, Jensen said.

“I don’t really think there is a nursing shortage,” Jensen said. “I think there is a shortage of hospital admin who are willing to pay and provide the benefits that it takes to recruit and retain health care workers. The nurses are there, we’re just tired. We feel that we deserve more.”

At the beginning of the pandemic, the health care workers were flooded with community donations and encouragement, from fresh flower bouquets to meals from local restaurants. Now, Jensen says, the workers still need community support, just in a different way.

She hopes the community will learn about the staffing issues hospitals around the state are facing. Then, she hopes, the community can help advocate for the safety of the workers and patients.

“Monroe is a publicly funded hospital,” Jensen said, “so tell administration what you want — that you support your frontline health care workers and that you want them to be listened to.”

EvergreenHealth Monroe is part of the Snohomish County Public Hospital District 1 and is governed by five publicly elected commissioners. The public hospital district is a community-created, governmental entity that operates much the way fire districts and school districts do.

Originally named Valley General Hospital, the hospital became affiliated with a King County public hospital district in 2015 and adopted the name of EvergreenHealth Monroe.