Bed management strategies help growing volume

From the left, John Sward, RN; Lisa Maciejak, RN, APSM, AED; Judy Catalano, RN; and Joanne Sullivan, RN, APSM, AED; discuss the flow of patients between their emergency departments into general medicine beds.
From the left, John Sward, RN; Lisa Maciejak, RN, APSM, AED; Judy Catalano, RN; and Joanne Sullivan, RN, APSM, AED; discuss the flow of patients between their emergency departments into general medicine beds.

As the number of patients seeking care at YNHH grew steadily over the past 10 years, the hospital developed strategies for bed management, including reducing length of stay and improving 11 a.m. discharge. While both strategies have been effective, volume has continued to grow.

The September 2012 acquisition of the 511-bed Hospital of Saint Raphael was a major boost in managing volume. To begin to properly assign patients to beds on the new, two-campus hospital, a group of doctors, nurses and clinical bed managers began work to streamline the process.

"Once we integrated, we began to analyze where our general medicine beds were on each unit and how we filled them," said Victor Morris, MD, vice president, Physician/Patient Access Services. "At times, we found that we had to admit some medicine patients to surgical units. Because of the overflow, we were not putting the right patient in the right bed the first time."

To begin to remedy the situation, YNHH invested in renovating two units on the Saint Raphael Campus. The 24-bed Medicine/Telemetry Unit on SLA 3 was re-opened in November and the Verdi 4 North medicine unit will open later this summer.

Patients who are diagnosed with illnesses like pneumonia, cellulitis, gastroenteritis and asthma can be admitted to general medicine beds on either campus.

Patients are generally admitted to the hospital through the Shoreline Medical Center ED and the two hospital EDs.

If, for example, a patient in the Adult ED on York Street has a stomach virus and is a candidate for the Saint Raphael Campus, a clinical bed manager lets him know that an ambulance will take him to the Saint Raphael Campus at no charge. On some occasions, the SRC Emergency Department has sent patients to York Street for specialized care offered on that campus.

"At first, we gave patients a choice of which campus they could be treated on but now we tell them that their room is ready for them," said John Sward, RN, patient service manager, Adult ED. "We are one hospital with two campuses and we have to assign beds appropriately to maintain safe patient flow. Patients overall are very understanding and just want to get care and go home."

"Patients have been largely satisfied with transferring from one ED to the other campus," said Dr. Morris. "Since June 1 when SRC went live on Epic, the transfers have gotten even easier.

Epic makes the process seamless and the patient's records transfer with them." Each day, Judy Catalano, RN, manager, Service Excellence on SRC, attempts to make a "friendly visit" to each patient who transfers to SRC from the Adult ED or the Shoreline ED to ensure patient satisfaction.

"We are able to transfer most patients from the Adult ED to their bed on this campus within one hour," said Catalano. "We ask them about their wait time, and if an issue is brewing with a patient or a family member, we launch service recovery immediately to mitigate the problem. We find that the vast majority are happy with their experience."