InvestigateWest’s reporting finds overcrowding in OHSU’s NICU is raising concerns among staff, patients

Conditions are becoming increasingly crowded in Oregon Health & Science University’s neonatal intensive care unit, raising concerns among patients and staff. That’s according to new reporting from InvestigateWest. Plans to expand capacity by building a new wing of OHSU’s Doernbecher Children’s Hospital have largely stalled despite rising demand for neonatal intensive care nationwide.

Danielle Dawson is a collaborative investigative reporter and Report for America corps member at InvestigateWest. She joins us with more details.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Geoff Norcross: This is Think Out Loud on OPB. I’m Geoff Norcross in for Dave Miller. In 2016, the leaders of Oregon Health and Science University shared some troubling details about the state of pregnancy and newborn care at the hospital. Babies and parents who need the kind of specialized care OHSU can provide were being sent there from all over the state, and there just wasn’t room for them all. Their solution was to build a new wing at OHSU Doernbecher Children’s Hospital. Ten years later, it has yet to be built. Danielle Dawson wrote about this for InvestigateWest, and she joins us now. Danielle, welcome to the show.

Danielle Dawson: Hi, Geoff, thanks for having me.

Norcross: Can you talk a little bit more about how OHSU is special? What kind of pregnancy and newborn care can that hospital provide that other hospitals in the state just can’t?

Dawson: OHSU is what’s called a Level IV Neonatal ICU, or NICU. This, in the American Academy of Pediatrics standards, is the top level of care. They provide highly complex surgeries or procedures for babies that have really medically fragile conditions. They also have a top labor and delivery unit, so they’re seeing patients that have the most acute care needs. And they receive transfers from all over the state and the broader region, so they are a very important part of the maternal care landscape in the state of Oregon.

Norcross: OK. Obviously important. Can you talk about the state of the facilities there in the NICU at OHSU Doernbecher right now?

Dawson: The NICU and labor and delivery units are both overcrowded and stretched thin. I spoke to six current and former employees of the unit, and they described a situation where they are currently caring for about 46 to upwards of 53 babies in the NICU at any given time. That is anywhere from 6 to 13 more babies than the NICU cared for just a decade ago. Nurses said that 50 babies is usually where it hits mission critical, in terms of the overcrowding. The space is too cramped for these babies.

This is one of the facilities that can care for babies with the most acute needs. Some of these babies could be as early as 22 to 23 weeks old, so they really need very attentive, specialized care. With such cramped conditions, there are a whole host of implications for the care that is being provided that nurses were concerned about. There’s a higher risk of infection potential and delays to care. Nurses described something as simple as having hand sanitizer next to a bed or gloves. There’s no space to do that. And so they have to walk in and out of rooms just to sanitize their hands every time they touch a patient.

Families have little to no privacy, and so this can have not only implications on their mental health, but also, it’s harder to bond with your child. And science, basically, with neonatal care, has stressed that family bonding is incredibly important to the outcomes of a baby.

Norcross: Obviously, OHSU leaders felt all these problems ten years ago. What did they ask for to address the problem?

Dawson: Doernbecher Children’s Hospital leadership presented a concept to build a new wing to the Children’s Hospital. This would allow them to increase their bed capacity for the NICU, as well as add new patient space for those patients that they’re receiving who are in labor, and this is before and after labor, so there’d be antepartum rooms as well as postpartum rooms, and these would also be in mostly private spaces, compared to the current layout of the NICU, which is described as a pod setup. So it’s similar to a nursery where you have multiple families in one space.

This project was also described as a way to bring the NICU and labor and delivery into a next generation of care, expanding the services that they offered to include those that were unavailable at the time to Oregonians outside of Seattle or San Francisco; and it’s worth noting that they did move forward with that expansion to services, but they haven’t built that requisite space that they had been discussing for some time as kind of a partner to that expansion.

Norcross: Why not?

Dawson: The project went through a number of fits and starts and pivots since it was discussed. At first, they had pivoted to a different hospital expansion project that would also have allowed them to increase their adult inpatient bed space. This later became the Vista Pavilion, which just opened this year. That project initially conceived of having four floors dedicated to the NICU and maternal care spaces, but during the pandemic, obviously, hospitals across the state buckled because of the lack of inpatient bed space. And so those four floors were scrapped and reallocated to the additional adult inpatient bed space.

Then they returned to the concept of a Doernbecher wing addition, and in the meantime, the financial situation of the hospital just became one that building a $425 million wing was just out of the picture.

Norcross: I think I hear you saying that finance has changed and priorities changed, too?

Dawson: Yeah, nurses that I spoke to said that they felt as if their needs were just falling in the list of priorities, even though this has been something that they have been discussing in some capacity for more than a decade. With the Vista Pavilion project, they were very hopeful that that would be the light at the end of the tunnel, but when those floors were scrapped, it was kind of back to the drawing board.

They felt when the Doernbecher building edition was revived, that that was the answer to their problems.

And then last year in April, they were informed that the project to build that wing would be put on pause as OHSU climbs out of its current financial situation, which was described at a recent board meeting as urgent but not emergent. They have turned a profit for the first time in a number of years, in the last half a year or so. But there still are considerations, like their cash on hand is quite low for hospital standards, and they did take out a lot of debt to build the Vista Pavilion, so they’re not necessarily in a state where they could take on additional debt to build the Doernbecher building addition.

Norcross: It sounds like the issues you’re talking about may be challenges that all hospitals are facing right now, like staffing and funding and patient volume and so on. What about OHSU? Are any of these factors unique to that particular institution?

Dawson: Yeah, a lot of these issues with capacity, they’re felt across the system. What is unique about the OHSU NICU is the care that they provide and the fragility of their patients. It also plays a very critical role in the statewide maternity and newborn care landscape. As a Level IV, they are one of the main referral destinations for patients across the state with incredibly complex conditions.

So when you have a facility like OHSU constantly at capacity, it makes it harder for patients in other parts of the state to be transferred and moved up that escalator of care. The Oregon Perinatal Collaborative last year put out a report that was based on a survey of all of the hospitals that have a birthing center in the state of Oregon, and the hospital leaders that were interviewed for this described concern about how frequently Level IV facilities like OHSU were hitting their capacity that made it harder for transfers to happen from one part of the state to another part of the state, and make sure that a high-risk patient receives the care that they need, whether that’s a laboring mother or a newborn baby.

Norcross: Have you talked to OHSU about all this?

Dawson: In a written statement, OHSU had acknowledged a lot of these problems that were flagged by nurses and said that the space must be improved and can be improved to ensure that the care that they’re providing is up to par with what they want it to look like. They have also talked about this issue publicly on a number of occasions throughout board meetings since 2016 when it was first discussed – the Doernbecher building addition.

The former CFO of the system said that the building project was representative of needing to get ahead of the curve to address demand pressures that were causing some of these capacity issues, but in their statement, OHSU had continued to reiterate that it is just financially out of reach at this time. They said that it would likely need a mix of philanthropic donations, state dollars, and debt in order to see it to the end.

And when I asked if there’s a timeline about when they may be able to return to the project, it was a little unclear. That has also been discussed in board meetings. Susan King, who’s the current chair of the OHSU board of directors, also asked this to the current CFO, Jeff Jones, and he said that their current capital investment priorities over the next couple of years, because of their financial situation, are mostly going to go towards things that are “non-sexy,” including getting the Vista Pavilion up and running, an emergency department renovation, which is also much needed, and then just general building maintenance across the university and hospital campuses.

I was told that they are looking to identify additional care sites to relieve some of the pressure on the current NICU space, but they did not provide any details about what that might entail and when those might come into play.

Norcross: Danielle Dawson, thank you so much for bringing us this information. I appreciate it.

Dawson: Thanks for having me.

Norcross: Danielle Dawson is an investigative reporter at InvestigateWest. We will have a response from OHSU Doernbecher Children’s Hospital on the show tomorrow.

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