April 19, 2012

Adult hospital copes with challenges of rising patient volumes

Adult hospital copes with challenges of rising patient volumes

Since January, the volume of patients treated in the Adult Emergency Department and those undergoing scheduled surgical procedures under the care of the Section of Surgical Sciences and Perioperative Services has soared.

During the past three months, patient volumes within Vanderbilt University Hospital (VUH) have surpassed all previous records. Resulting volume increases in the ED and Perioperative Services, coinciding with ongoing demand for many other adult services, have caused the hospital’s average daily census remaining at or near capacity.

Careful analysis reveals the surge in adult inpatients isn’t from a single disease or diagnosis, but rather the result of an overall increase in demand for Vanderbilt’s services.

From a business perspective, increased volume seems an ideal predicament. However, on several days a surge in inpatients at VUH has necessitated an appeal to area emergency medical service providers to divert patients with certain categories of illnesses away to other facilities.

“I want everyone to understand we are acutely aware of the high demand for Vanderbilt’s services and the challenges additional patient volume places on our faculty and staff, not only in the Emergency Department and Perioperative Services, but throughout our system,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and CEO of the Vanderbilt Health System.

“The sustained increase in volume speaks both to the high quality care we deliver and the overall Vanderbilt experience. I am grateful for everyone’s hard work and continued commitment as we work as quickly as possible to address the current need for additional inpatient bed space.”

Next month, as construction ends on the seventh floor of the Critical Care Tower (CCT) in VUH, an additional 34 beds will become available. In October, another 34 inpatient beds will become available on the 10th floor of CCT, which will house the new Myelosupression Unit.

While both inpatient and outpatient volumes have remained consistently strong all year for the Monroe Carell Jr. Children's Hospital at Vanderbilt, pediatric services have not faced a similar need to request hospital diversion.

During recent months, the adult ED has been over 100 percent capacity some of the time. Patients admitted to VUH spend time holding in the ED until inpatient beds become available.

“Though the system we use in the Emergency Department is both innovative and seen as a model nationally, it still has many patients waiting long hours in our waiting room,” said Corey Slovis, M.D., professor and chair of the Department of Emergency Medicine. “We have taken additional steps to address this problem such as adding one additional Emergency Medicine faculty member who works with nurses, paramedics and technicians who now staff an area adjacent to the waiting room starting workups of patients who may experience a protracted wait for a room. The response from the entire Emergency Department team has been nothing short of heroic. I am proud to say that even under a system that’s been stressed for several months, the care delivered by our physicians, nurses and staff has been some of the best in the nation.”

As a result of the added patient volume, the ED’s triage physicians have been encouraged to identify patients who can be safely seen in an ambulatory clinic setting. These patients will be appropriately evaluated and deemed stable and safe for transfer to a VMG clinic.

“We need everyone’s assistance facilitating our ability to get these patients seen in our clinics, as requested by the ED,” said Paul Sternberg Jr., M.D., assistant vice chancellor for Adult Health Affairs and chief medical officer for VMG.

“Please note the ED will only send patients who are already followed in your clinic. We have coordinated with the VMG Business Office to flag these patients’ bills so that they do not receive professional services bills from both the ED and VMG providers.”

Faculty of the Section of Surgical Sciences and administrators and staff of Perioperative Services have also been working since January under an increased demand for services.

“In my 17-plus years at Vanderbilt, I have never seen us more filled to capacity with patients. There is ever-greater demand for highly specialized procedural services. We expect to exceed 31,000 operative cases, just within the Adult VUH, for this fiscal year — more cases than we have ever done within the walls of this hospital,” said R. Daniel Beauchamp, M.D., John Clinton Foshee Distinguished Chair in Surgery and chair of the Section of Surgical Sciences.

Beauchamp said that across VUMC, including Children’s Hospital and the Medical Center’s ambulatory surgery centers, the institution expects to exceed 50,000 operative cases by the end of the current fiscal year.

“Thanks to very active management by nursing, hospital administration and physician leadership, we have been able to identify opportunities to reduce lengths of stay, facilitate discharges and transfers of appropriate patients, and to create the bed capacity for these surgical patients so that case cancellation is a rare occurrence. We are looking forward in both VUH and Children’s Hospital to the additional beds that will come online within the next few months,” Beauchamp said.