ED Patient Surge for Mental and Behavioral Health; Elevated RSV Rates Prompt Changes to Masking/Visitor Policies

ED Patient Surge for Mental and Behavioral Health

From: Dr. Jeff Ojemann, SVP and Chief Medical Officer, Bonnie Fryzlewicz, SVP and Chief Nursing Officer and Dr. Tony Woodward, ED Medical Director

Seattle Children’s continues to see an extremely high number of pediatric patients seeking care for mental and behavioral health emergencies.  Thank you for your continued efforts to manage lower-acuity complaints, including lower-acuity mental and behavioral health concerns, in outpatient settings when appropriate.

The ED is also seeing increased census in viral illnesses (see our Nov. 16 update on RSV/synagis/nirsevimab). RSV activity is high and has not peaked yet. Influenza activity is starting to rise locally.

Patients experiencing any type of medical emergency, including a child at imminent risk of harm to self or others, should seek immediate care at an emergency department.

Code yellow activated

We have activated a code yellow to manage our response (a code yellow opens an emergency operations center and formalizes an incident command structure for rapid communication and implementation of plans). We have implemented surge plans that help increase our capacity, and we are employing new tactics to allow us to better manage surges of ED patients and maximize use of beds in the Psychiatry and Behavioral Medicine Unit. However, we continue to see a significant proportion of our ED beds occupied by mental and behavioral health patients awaiting disposition, and some families may experience long waits.

The challenge of children and youth “stuck” while awaiting their next step in care is a crisis nationwide. Across Washington State hospitals, levels of patients awaiting disposition are at an all-time high.

Other actions we are taking 

While we recognize that systemic, statewide solutions typically take time to identify and implement, we are working with statewide partners to add resources and improve processes outside of Seattle Children’s. This is an important part of working toward long-term, sustainable solutions and will likely continue in the months ahead.

In order to raise awareness of these challenges and share relevant resources, we have reached out to numerous partners including leadership of state agencies, hospital partners through the Northwest Healthcare Response Network (NWHRN), key state legislators, Washington’s federal congressional delegation, the Washington State Governor’s Office, and local partners including School Based Health Centers and Public Health – Seattle and King County.  We continue to collaborate to identify and advance solutions in the short-, medium-, and long-term.

Thank you for your continued partnership.

Please contact Tony Woodward, ED Medical Director and Division Chief, with any suggestions, questions or concerns: tony.woodward@seattlechildrens.org.

High-Transmission Protocols Effective Nov. 20 Include Masking and Visitor Restrictions

From: Ruth McDonald, VP and Associate Chief Medical Officer (Hospital Operations) and Chief Medical Operations Officer; Bonnie Fryzlewicz, SVP and Chief Nursing Officer; and Danielle Zerr, Medical Director of Infection Prevention

Due to elevated transmission rates of respiratory diseases – specifically, RSV rates – Seattle Children’s has updated its masking, PPE, visitor and other policies. These changes took effect Monday, Nov. 20.

Masking changes

• Everyone in clinical areas – workforce members, patients and families – will be required to wear a mask.
• Masking will be recommended in non-clinical buildings and spaces.

Personal protective equipment (PPE) changes

• Eye protection is required for all clinical encounters.

Visitor policy changes

• Inpatient:
  • Four people (caregivers and/or adult visitors) allowed at bedside at a time (two dedicated caregivers may stay overnight).
  • No sibling visitors under 18 years. Patients who have or are anticipated to have an inpatient stay of 30 days or more are permitted to request a weekly sibling visitation.
  • No non-sibling visitors under 18 years.
• Ambulatory:
  • A total of 4 caregivers and siblings are permitted to accompany the patient to their visit. It is preferred that siblings stay home and caregivers are limited.

Why did we update our policies on Nov. 20?

• Seattle Children’s, along with other healthcare systems across the region and the Northwest Healthcare Response Network (the Network), has adopted interim thresholds for universal masking to prioritize the health and safety of patients and employees.
• The Network’s latest update on masking in acute care and outpatient clinics is here.

For more information: Find our updated policies on our website.