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Staff at YNHHS’ Capacity Coordination Center use electronic dashboards displaying real-time data on bed availability, patient transport status, ED operations and other activities to help coordinate patient throughput. The Center is critical to the health systems’ efforts to manage significant capacity challenges.

Untangling the capacity challenge
“Busier than we’ve ever been,” YNHHS seeks creative solutions to patient throughput puzzle 

The first in a series of articles examining the reasons for record patient volume and YNHHS’ efforts to overcome capacity challenges. 

You’re cruising down the highway, making good time, when you see brake lights up ahead. Traffic is crawling, and you think, “What’s going on?”

Healthcare organizations nationwide, including Yale New Haven Health System, are experiencing their own kind of “traffic jam,” with many hospitals at or over capacity. While it’s usually easy to pinpoint the cause of a traffic jam on the highway – an accident, bad weather or construction – the healthcare traffic jam has multiple, complex causes that are interconnected, and challenging to fix. 

COVID-19 patients are inundating hospitals in some states, but that’s not the case in Connecticut or at YNHHS. After a second surge brought more than 440 COVID-19 inpatients to YNHHS hospitals in December 2020, COVID-19 numbers have significantly declined overall. 

And yet, “we are busier than we’ve ever been,” YNHHS CEO Marna Borgstrom told employees during an Oct. 18 town hall. 

That day, YNHHS hospitals had around 60 COVID-19 inpatients and 2,200 non-COVID inpatients, leaving the health system over capacity for adult inpatient beds. In fact, most of YNHHS’ five hospitals have been at or very near inpatient capacity since summer 2020, when the first COVID-19 wave ended and ambulatory operations reopened. One day in early October, Bridgeport Hospital was at 113 percent capacity. 

During the Oct. 18 town hall, Borgstrom noted that at one point that day, 172 patients were in the Yale New Haven Hospital Emergency Department’s three locations (the York Street and Saint Raphael campuses and Shoreline Medical Center). Of those, 90 had orders to be admitted to an inpatient bed, including 15 who had been waiting for a bed for over 24 hours. Also that day, 128 patients were in Bridgeport Hospital’s ED, which has 40 treatment bays. 

What’s going on? For one, hospitals are seeing more, and sicker, patients.

“A number of these patients avoided going to the hospital or their physicians’ offices for treatment during the height of the pandemic,” said Ian Schwartz, MD, YNHHS senior vice president, Clinical Operations. “Now their existing medical conditions have become more serious, which usually translates into longer hospital stays.”

More patients staying longer mean fewer available inpatient beds, which means patients end up boarding in the EDs. Teams throughout YNHHS are exploring ways to ease these bottlenecks without compromising patient care and safety. 

Compounding capacity issues is a nationwide demand for employees in nearly all industries. This fall, YNHHS had 3,000 clinical and non-clinical positions open. 

“We have an unprecedented number of open positions and fewer qualified applicants than at any time in recent memory,” said Melissa Turner, YNHHS chief human resources officer. “And we are not alone.”

The pandemic is partly to blame for the employee shortage, particularly in health care. Physically, mentally and emotionally exhausted by the pandemic, healthcare employees are switching from full- to part-time jobs; trading permanent positions for more lucrative, flexible temporary jobs; or leaving health care altogether. YNHHS’ Talent Acquisition team is working hard to recruit high-quality employees and find ways to keep them in the system.

Right now, teams of staff, physicians and leaders are tackling these and other capacity problems, devising ways to improve patient flow and ensure that YNHHS employees can continue providing the safest, highest-quality care and patient experience. 

“Just as we did with COVID-19, it will take all of us working together to overcome these significant challenges,” Borgstrom said. “I feel confident that we’re going to get it right.”