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“Everyone jumped into action” during record-setting surge in patient census


Marna Borgstrom, YNHHS CEO, (right) was among the Yale New Haven leaders who visited different areas of the hospital during the recent Code D surge, including a North Pavilion conference room that was converted into a patient care area. Nursing Resource Operations Center staff covering this and many other areas of the hospital included (l-r): Anslem Emenyonu, RN, NROC assistant patient service manager; Nella Tulloch, patient care associate; Mary Botchie, patient care associate; Krista Hardy, RN; Cali Rivas, RN; Tom Buzzelli, RN; and Laura Jansen, RN, NROC clinical coordinator.

In her 16 years as a Yale New Haven Hospital Emergency Department nurse, Jamie Giaquinto, RN, has seen a lot.

But she’d never experienced anything like the number of patients who inundated all four YNHH Emergency Department locations last month. At one point on Jan. 7, the York Street Campus Adult ED, Pediatric ED, Saint Raphael Campus (SRC) ED and Shoreline Medical Center ED combined had a record 114 inpatients holding, awaiting admission to a hospital bed. At the same time, the hospital hit an inpatient record, with 1,508 patients. 

Even with so many patients in waiting rooms, treatment rooms and on beds in hallways, a sense of calm resonated throughout the SRC ED, said Giaquinto, assistant patient service manager. “You would never have known we were hitting record numbers. Everyone – nurses, nurse managers, techs and doctors – jumped into action and knew what to do. We worked together so smoothly, with one common goal: to take care of the patients.” 

The surge prompted YNHH leaders to call a Code D (Facility Alert: Surge Disaster) and activate the Hospital Incident Command Team. Composed of medical providers and leaders from clinical and non-clinical departments, the team can quickly make staffing, facilities and operations changes to manage complex situations. 

The surge was definitely a complex situation, with a cause that was difficult to pinpoint. But the solution was clear: Free up existing beds, add new ones and increase staffing. 

Over the next several days, the Hospital Incident Command Team coordinated operations involving numerous people in many different roles and departments. They included Care Coordination staff, who worked additional hours to streamline safe discharges and provided taxi vouchers so some patients wouldn’t have to wait for rides. Staff from Facilities, Information Technology Services, Materials Services and many other departments helped convert the York Street Campus Max Taffel conference rooms into a “discharge lounge.” Environmental Services staff performed 410 discharge room cleans a day to get newly vacated inpatient beds ready quickly.  To ensure all inpatient beds were being used, the hospital expanded admission criteria for the SRC Main 6 Gastrointestinal/Bariatric unit. Some patients ages 18 - 25 were seen in the Pediatric Emergency Department and admitted to Yale New Haven Children’s Hospital.

To add beds, staff turned some single-bed rooms into doubles on existing inpatient units and opened patient care areas in unused space on Verdi 2 South and in a North Pavilion 4 conference room. Nursing Resource Operations Center (NROC) staff cared for patients in these and other areas.

“They were so open-minded and adaptive,” said Laura Jansen, RN, NROC clinical program director. “Throughout the hospital and health system, there was a tremendous team effort among all employees. Everyone worked together to put patients first.”

Some of the strategies implemented to manage the recent surge have been used to handle high patient volume in the past, while others were new, said April Alfano, YNHH manager of Disaster Preparedness and Response. A number of these strategies will become permanent to help with the ongoing high patient census and future surges. The hospital is also recruiting additional staff in certain areas.

YNHH is even better prepared for future Code D situations, thanks to the work of the Hospital Incident Command Team and all Yale New Haven staff, physicians and volunteers, said Michael Holmes, senior vice president, Operations, and Hospital Incident Commander.

“Everyone across the hospital and health system should be extremely proud of what they accomplished.”