Raymond Rudoni, M.D., FACEP
With winter here and flu season upon us, EDs and hospitals nationwide are once
again confronting the issue of diversion. Across the country, suburban
teaching hospitals like McLaren Regional Medical Center are faced with a
demand that is greater than capacity, and closing the ED to monitored
ambulance traffic is a real time problem.
ED ambulance diversions continue to receive national attention from not only our specialty peer reviewed journals, but also from the local and national news media that have jumped on board. Recently, there have been articles in Newsweek, Ladies Home Journal and the Institute of Medicine Report.
Bottomline: this problem is growing faster than solutions, and irregardless of
your position at the hospital, creating short and long term solutions to
capacity limitations (or at time staffing shortages) is in everyone’s best
interest–especially our patients.
Short Term Solutions
Short term, the facility is renovating an adjacent, patient registration area
and creating eight monitored capable patient care areas to be used as an
overflow tactic. Once the ED gets four non-ICU holders (for example, admitted
patients who do not have an immediate in-patient bed assignment), a nurse will
be assigned to the overflow area, and the four holder patients will leave the ED
and be taken to the overflow area. The next four patients will prompt a second
nurse and four more transfers will occur. This process will minimize the number
of holders occupying valuable ED resources required to evaluate new patients.
This renovation should be completed in early January 2007.
Also included in the short term strategies is the addition of six extra monitored beds, brought back on line, to maximize capacity on the 6th floor. Finally, Select, a long term care company that has contracted with McLaren, will begin providing special services for long term in-patients. By default, the addition of this service (summer 2007) will off load the ICU’s chronic patients (who are trached and vented, for example) and create a greater ability to triage downstream and open crucial ICU beds.
All three of these short term solutions will increase the ability of in-patients
to move from the admitted state in the ED, to the in-patient setting, which will
in turn keep ED doors open to ambulances. In other words, maintaining ED access
in a fixed space is only possible if admitted patients are moved out of the ED!
Long Term Solutions
Finally, long term solutions reside in McLaren’s ED renovation which will double its size, and should be complete in 2008. The new ED will have more hall space, an increased number of triage areas to treat and potentially hold in-patients, if needed, and finally an ED observation unit designed to introduce a rapid decision making philosophy which will also keep non-urgent patients out of valuable monitored beds on the in-patient wards.
National ED diversion occurrences are increasing in an exponential fashion and our communities and patients are looking to hospital and medical leadership to ensure hospital (ED) access is maintained. Every solution takes time, resources and creativity but must be a priority of those looking to be community leaders in overall health care.
I would like to personally applaud McLaren’s leadership team, for not only
acknowledging the ED diversion challenge, but for taking a pro-active approach
to a difficult problem by offering solutions and valuable resources to ensure
McLaren will always be accessible when the community needs medical care.