This article, in the Lakeland Florida Ledger, is about 20 patients that were diverted from Lakeland Regional Medical Center in just over 6 hours this past Tuesday.  Each of these 20 potential admissions represents  $50,000 to $75,000 in missed revenue.

The cause for this emergency department overcrowding?  A bottleneck in the ICU.  This was their first complete diversion, attributed to increasing ED visits and hospital admissions.  In addition to lost revenue, the diversion increased costs as the hospital geared up efforts to clear beds for new admissions.

Two common causes for ED diverts are bottlenecks in the ICU and Telemetry.  Why?  Many patients end up in these two units when they need monitoring, regardless of their acuity.  Various studies have put the percentage of inappropriate ICU admissions between 17 and 23 percent.  These are avoidable ICU over-stays, readmissions or off-service admissions made in an effort to "bring the patient to the monitor."  This care model provides more than appropriate care in the highest cost setting for this group of patients.

One solution to this problem goes by various names: universal bed, universal unit, variable acuity beds, flex beds and flexible monitoring.  The goal is to provide appropriate care in the lowest cost setting, and results in shorter LOS and reduced intra-hospital transfers.  The biggest change with this new care process is caring for a broader range of patient acuity in general care units (in some cases up to a level equivalent to high dependency units).  Thus when a patient shows the first signs of crashing, or that hip replacement patient starts to throw PVCs after surgery, monitoring and clinical intervention can be done in their unit without the traditional transfer to ICU or Telemetry.  This process provides appropriate care in the lowest cost setting and frees up ICU and Telemetry beds for the truly acute patients who need them most.

Improving patient flow is not a panacea, but it can create “virtual beds” until bed expansions come on line and reduce the number of new beds needed to be built out.

The story also mentioned that overcrowding is endemic throughout Florida, with frequent problems mentioned in Polk, Hillsborough, and Marion counties.