The Washington Medical Coordination Center
The first week of the COVID pandemic’s emergence in Kirkland, WA saw a single nursing home overwhelm a highly capable regional hospital when 33 of 37 patients were transported to this single hospital over a 10 day period. To mitigate this, Harborview’s role as the long standing statewide disaster medical coordination center (DMCC) was utilized and expanded to create the Washington Medical Coordination Center (WMCC) to address the need for both surveillance of congregate settings which could overwhelm healthcare resources and to level load patient distribution across a large geographic region. The WMCC was founded by Dr. Steve Mitchell, currently serving as its Medical Director and Mr. Mark Taylor, who serves as its Director of Operations.
The WMCC is designed to balance patient placement to individual or multiple hospitals with sufficient capacity in order not to strain the resources of any single hospital or small group of hospitals. While DMCCs are primarily activated in short-term acute incidents, the WMCC is an ongoing service to help manage the healthcare impact of patients requiring hospital-level care during times of health-system stress as a result of the pandemic. As noted, the WMCC was created during the initial COVID outbreak. It was originaly named the Regional Covid-19 Coordination Center (RC3) with a focus on assisting western Washington healthcare partners but has now evolved with the pandemic to support all Washington State healthcare facilities.
The WMCC is designed to place patients from any hospital or long-term care facility requiring the nonemergency transfer of a resident(s) or patient(s) to an acute care hospital. The WMCC supports placing several patients at one time or can assist smaller facilities by placing fewer patients as resources allow. The center also serves as a coordination hub for decompressing hospitals at or beyond capacity by placing patients from impacted acute care hospitals to similar settings as requested. The WMCC supports patient transfers by working directly with facility transfer centers and referring clinicians. It is not meant to take precedence over the placement strategies that may occur within a hospital system; rather, the WMCC supports facilities when standard resources and facilities are unable to meet current needs.2
Prior to the pandemic, Washington State did not have a way of tracking bed capacity in a manner that could be effectively applied to regional or state level loading processes. In addition, it had no way to determine the disease burden of pandemic patients at each hospital. In response to this need, Dr. Mitchell worked with leaders at Microsoft, the Northwest Healthcare Response Network and the WA State Dept of Health to create the WA Health data platform to assist the work of the WMCC and to guide state leaders and policy makers regarding the pandemic.
WA Health currently tracks every pandemic related constrained resource. This includes staffing, beds (critical care and acute care), equipment (ventilators, PPE) and staffing. It has also expanded to include vaccine tracking and is synced with federal government reporting services to avoid data input duplication by hospitals.
As a result of the work of the WMCC, the State of Washington is the only state to have a signed statewide agreement by all healthcare chief executive’s that details the role of the WMCC and an agreed upon statewide level loading strategy. The signed operational framework includes the methodology of how level loading is accomplished, data sharing transparency and quality assurance review of the work.
The WMCC is now considered a model structure for disaster preparedness and response across the United States.3. Leaders from the WMCC were instrumental in the development of Health & Human Services/ ASPR Medical Operations Coordinating Cell’s Toolkit and a guide for setting up regional coordination centers in conjunction with the American College of Surgery.4,5 This resource which assists regional and state level leaders in structuring a coordination center to address s flexible and modifiable guidance, aimed to assist regional, state, local, tribal and territorial (SLTT) governments to ensure load-balancing across healthcare facilities and systems so that the highest possible level of care can be provided to each patient during the pandemic.
As the impacts from COVID-19 (hopefully) begin to diminish, the WMCC is now looking to the future with a goal of transitioning to a permanent coordination center which provides on-going operational patient placement assistance while also serving to prepare and plan for all hazards scenarios which may require widespread patient placement services as part of our states disaster preparedness and response capabilities.
- Morris, SC, Resnick AT, England SA, Stern SA, Mitchell SH. Lessons learned from COVID-19 outbreak in a skilled nursing facility, in Washington State. Journal of the American College of Emergency Physicians Open. 2020;1-6. https://doi.org/10.1002/emp2.12137
- Mitchell SH, Bulger EM, Duber HC, Greninger AL, Ong TD, Morris SC, Chew LD, Haffner, Sakata VL, Lynch JB, Western WA COVID-19 Expert Panel, Western Washington COVID-19 Experience: Keys to Flattening the Curve and Effective Health System Response. Journal of the American College of Surgery, 2020 Jun 16;S1072-7515(20)30488-9.
- Stewart RM, Bulger EM, Epley E, Mitchell SH. How to Set Up a Regional Medical Operations Center to Manage the COVID-19 Pandemic. American College of Surgery website. April 3, 2020 [online clinical guidance, https://www.facs.org/covid-19/clinical-guidance/rmoc-setup]
For more information on WMCC, please visit the Northwest Healthcare Response Network website.