A patient-care ombudsman watching over Astria Health’s bankruptcy has noticed growing demands on the organization’s nurses, she said during a status conference Friday in court.
The ombudsman, Susan Goodman, visited Astria Regional Medical Center in Yakima on Thursday, where she met a nurse who ended up working a 16-hour-shift, rather than the standard 12-hour-shift, to ensure there was enough patient coverage.
There have been other instances of nurses having to work longer hours to ensure sufficient patient coverage, said Goodman, an Arizona attorney appointed by the court to monitor patient care at Astria Health’s facilities while it undergoes Chapter 11 bankruptcy protection.
“There’s very little bench in terms of extra people,” she said.
Astria operates hospitals in Yakima, Sunnyside and Toppenish, along with a network of clinics.
Goodman’s comments mirrored the ones she made in a report she filed with the court earlier this week. The report covers recent visits to all three hospitals and several clinics but focused primarily on Astria Regional, where she stated most of the unofficial staff departures and reductions were occurring.
In that report, she notes that during recent visits she observed patients were being held in Astria Regional’s emergency department because nurses weren’t available in the intensive or acute care departments.
This was especially noticeable with the hospital seeing an increase in its daily census due to the cold and flu season. That increase resulted in “nursing staff functioning at maximum staffing assignments, leaving no one to take a new admission,” Goodman wrote.
The nursing staff issues also were causing delays and cancellations in elective surgical procedures, Goodman said.
In an email response, John Gallagher, CEO of Astria Health, said the staffing issues raised by Goodman are not unique to Astria Regional.
He said Astria Health has worked on recruiting staff and has hired for 437 open positions so far this year. Astria Health also has used more travel nursing staff.
“First, hospitals throughout the country actively manage patient care demands and available resources in terms of emergency room admissions, patient flow and patient staffing,” he wrote.
Goodman said she was concerned about the impact of staffing and other issues on patient care but emphasized that Astria Regional was still ultimately meeting patient ratios.
“(But) we certainly don’t want to wait until there is a patient safety issue,” she said.
She also expressed concern that Astria Regional is diverting patients to other medical facilities due to staffing issues.
“You can’t constantly go and divert because you’re challenged from a nursing perspective in terms of patient ratios,” she said.
Gallagher said diverting patients is not a common practice with Astria Regional Medical Center but said diversions occur for “limited periods of time” to clear patient backlogs. He said that is a practice common in other hospital emergency rooms.
Nurse staffing was the main issue that Goodman addressed in her report, but she took note of other potential concerns:
• Goodman observed the impact of recent layoffs and consolidation by Astria Health on its services. For example, the layoff of some Astria Regional social work team members led to the shift of discharge planning follow-up to nursing supervisors and clinicians.
She also noted the elimination of a lab technician at one of Astria Health’s clinics in Yakima that led to a temporary halt of lab draws at that location.
“Given the volume of lab draws previously performed at this clinic and the abruptness of the service elimination, (I) expressed some concern surrounding both the patient notification process and the development of quality auditing to ensure that important lab monitoring is not missed.”
In his response, Gallagher said Astria Health avoided layoffs in areas “that affected direct patient care.” He notes that the lab manager is still an Astria employee and that lab draws are now done at the hospitals rather than at the clinics. Doing so “allows for more efficient delivery of care, and seeking more efficient care delivery is a necessity being experienced nationally throughout the industry and is not unique to Astria Health facilities.”
He adds that Astria Health decided to consolidate its social worker positions at Astria Regional after examining industry productivity standards.
• In a footnote in her report, Goodman noted the recent closure of Astria Regional’s oncology clinic and chemotherapy unit, which had only been open for a handful of months. “Certainly this change can be attributed to the bankruptcy and any care gaps resulting from it would represent significant and material patient care impacts.”
Astria Health has decided to focus its oncology services at its cancer center location in Sunnyside, Gallagher wrote. Patients who were being treated in Yakima will now be treated at the Sunnyside cancer center. Ultimately, the organization decided it was best for Astria Regional to focus on core services, such as open-heart surgery, neurosurgery, emergency services and trauma care.
The decision was made “due to the high costs associated with opening new service lines and running duplicate programs,” he wrote. Astria Health is evaluating whether oncology services could again be offered in Yakima, he wrote.