Salem Hospital is again diverting ambulances to other hospitals for the first time since this summer as a wave of respiratory virus infections has helped fill the hospital to capacity regularly.
The latest rounds of diversion began Thanksgiving weekend, due to a rise in flu, Covid and RSV cases in the weeks before the holiday.
“There were a lot of people in the emergency department at that time, to begin the weekend, we had the inpatient space to accommodate patients but as the weekend wore on it became clear that we were just running out of space for everybody,” Dr. Peter Hakim, an emergency department physician.
The hospital has been under diversion 10 times since Thanksgiving for periods ranging from one to 19 hours, Salem Health spokeswoman Lisa Wood said.
The diversions began as hospitals throughout the state face capacity issues due to a surge in respiratory syncytial virus cases combined with an increase in Covid and flu hospitalizations.
On Wednesday, Gov. Kate Brown issued an executive order due to the sustained strain on hospitals. The order followed a Nov. 14 executive order and emergency declaration which deployed emergency health care professionals and designated emergency health care centers, aiming to provide more resources to pediatric patients.
Since then, statewide RSV pediatric hospitalizations have broken previous records, and Covid hospitalizations have returned to July 2022 peaks, according to the order.
The expanded order allows for many of the same measures and aims to provide hospitals additional flexibility and resources.
As of Nov. 30, 97% of ICU beds were occupied in the region that includes Benton, Lincoln, Linn, Marion, Polk and Yamhill counties, according to the Oregon Health Authority.
Salem Hospital’s diversion policy aims to preserve hospital capacity, which is consistently near or above 100%, Wood said.
As of Dec. 2, Salem Hospital had 30 inpatients with Covid, and 419 of the 415 adult acute and critical care beds were in use, or 101%.
The hospital’s diversion policy, which changed in July, triggers a temporary pause on receiving patients with non-life threatening injuries from ambulances. These patients are taken to other hospitals.
The policy does not apply to patients who walk in the door or arrive with private transportation, who will still be received regardless of diversion status.
Salem Hospital diverted patients for the first time in over a decade on July 26, a pause that lasted under four hours, said Wood.
Salem Hospital activated divert for the second time on Nov. 29. The hospital reassesses its divert status every two hours.
In Dallas, Salem Health’s West Valley Hospital has separate divert triggers but has also been on various periods of divert since November 29, Wood said.
Where a patient will go is decided within an emergency transportation vehicle. Any patient who arrives at Salem Hospital is not then sent to a different hospital, Hakim said.
“When a patient arrives here, they are seen and taken care of here. Diverting happens in what we call the prehospital setting, so (emergency medical services) fields, fire, the different crews that transport patients to the hospital,” Hakim said.
Patients with non-life threatening injuries are sent to the next hospital that is accepting patients, he said, including in West Valley, Santiam or Silverton.
Regardless of diversion status, patients who cannot safely handle an increase in travel time are taken to Salem Hospital.
There are various requirements that trigger the diversion policy when it is revisited every two hours. Considerations include capacity, status of various departments, staffing levels and how many people are expected to be discharged.
“There’s not any one trigger that says, ‘okay, based on x number of patients we are now on diversion,’ but it’s really kind of a complicated algorithm. And also trying to anticipate the needs of the community,” Hakim said.
Hakim said patient length of stay is one of the biggest factors in hospital capacity issues. He said the average length of stay has increased by around two days in the past few years, largely due to understaffed rehab centers, care facilities and nursing homes.
“That adds up and just compounds downstream. And there’s no place more downstream than the emergency room, where if patients can’t leave the hospital then new patients can’t get into the hospital, then they are stuck in the emergency room,” he said.
Contact reporter Abbey McDonald: [email protected] or 503-704-0355.
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Abbey McDonald joined the Salem Reporter in 2022. She previously worked as the business reporter at The Astorian, where she covered labor issues, health care and social services. A University of Oregon grad, she has also reported for the Malheur Enterprise, The News-Review and Willamette Week.
