Day: March 7, 2005

Grand Rounds

Grand Rounds is a weekly round up of medical weblogs.  I submitted an entry over the weekend, and just received notice that it was accepted.  You can see my entry, along with many others,...

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ED Overcrowding and Diversions In Real Time

Two sites have come to my attention that indicate real time divert data. The first is a site that covers an eight-county region in South Central Pennsylvania.  The status of (17) hospitals is hosted at this site. You can visit the website at The site is based on a package by Med Media, who has a number of EMS solutions. As I'm writing this one of the region's three trauma centers is on divert (Lancaster General), and Gettysburg Hospital has overcrowding in Critical Care, General Medicine and General Surgery.  Oh, and Memorial Hospital is on ED divert as well. And while I was adding links to this post, Good Sam also went on divert.  That's a total of one quarter of this regions hospitals on divert. Wait, there's another one!  Ephrata Community Hospital has joined the ranks of the diverted.  This link is to Credit Valley Hospital, a 365 bed hospital with 20,000 admissions annualy, in Mississauga, Ontario (a Toronto suburb).   At the middle of their home page at the bottom, there's a stylized picture of an ambulance. Below that it says, "Click here to view our ER admit status."  Here's what the link says this evening: At the present time we have 23 patients in the emergency department requiring admission to hospital. Because all of our inpatient beds are full, these patients will remain on stretchers in the emergency...

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Bed Management Issues and Financial Impact

The other day I came across a Baltimore Business Journal article from late last year that describes patient flow experiences at Baltimore area hospitals. There is some good background on the problem like the impact of capitated reimbursement and the rapid drop in LOS in the '90s.  But the rapid drop in LOS started to level off in the late '90s because the easy fixes to patient flow problems, like optimizing individual departments, had been done. Impacting patient flow (and reducing LOS) today requires cross-silo organizational review and broad based solutions. The solution of final resort is adding capacity.  At a cost of $1 million per new bed, building your way out of a capacity problem is an expensive proposition. "The system doesn't like to pay a lot for standby capacity," said Caroline Steinberg, vice president for trends analysis for the American Hospital Association in Washington. "It's a balance of extra capacity that the system is willing to pay for to make sure you only have gridlock a certain percentage of the time." Solutions discussed include: the addition of hospitalists acquiring capacity management software increasing hospital operating hours from 5 to 6 days per week optimizing diagnostic testing aggressive discharge management Of course this is a partial list of fixes, and few of them are quick and easy. Johns Hopkins was the exception.  Their secret was, "asking doctors where the problems...

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