By Carmen M. Woodson-Wray, Gary Crusader
At least three times a month, the Methodist Hospital’s Northlake Campus experiences overcrowding at the hospital’s emergency room. This happens most often on Mondays when patients begin to not feel good Fridays and try to wait to see their physician on Monday.
With their symptoms worsening over the weekend, the patients end up in the emergency room on Monday. Since the hospital is very familiar with this situation they have a plan in place referred to as its “High Census Alert,” where every department of the hospital is alerted and prepares to go into action.
Cindy Mele, director of Emergency Services, Trauma Services and the Regional Coordination Center, said when the hospital is full, there are three phases defined for staff in a hospital policy: Phase 1 – The hospital campus is at 90 percent capacity and an overhead announcement is made to alert all areas. Each area starts working on specifically assigned tasks to mobilize patients. For example, EVS moves a cleaning team to an area with discharges to clean rooms in a timely manner; doctors come in to round/ discharge their patients; and patients with lesser acuities may be moved to another nursing floor. The goal is to provide safe and quality care to all our patients.
In Phase 2, the volume of patients continues to grow, and the Emergency Department (ED) starts to experience wait times in the lobby and have patients being held wait for a bed to become available on an appropriate nursing unit. You may hear them referred to as ED boarder patients. For these patients, their care continues. ED nurses speak with the admitting physician and care orders are taken. While it is the goal to keep all of the patients comfortable, sometimes the wait for a bed upsets patients. In reality, this is a very safe place for them. Their care is continued with a close eye by ED nurses, and a physician is available at all times. This is so much safer than being at home where anything could happen.
In Phase 3 when all resources have been exhausted and patient volume continues to grow, the hospital would close its doors to incoming ambulances. This is called diversion or bypass. At Methodist Hospitals, processes have been refined to the point where this does not happen. The practice is to work as a close team to move all patients safely.
Methodist Hospital has not been on a diversion for High Census in over five years, and it is their belief to always be available for their family and friends within the community to have access to medical attention. They take this responsibility very seriously. Therefore, their team of highly- engaged and dedicated medical providers work to find solutions to the volume overload problems.
The hospital’s options are put in place so that everyone in the organization can take immediate action to start mobilizing patients.
Mele said, “These processes have been put in place to improve the quality of care we provide to our patients and are not considered a state of emergency. These processes assist us by having procedures in place to be able to care for our patients as quickly as possible.”
She added that the best option is to maintain the patients in the Emergency Department to provide quality care.
“However, we always have the option of moving a patient to our sister campus in Merrillville if there is a bed available and the patient is in agreement to the transfer. Occasionally, we have a request to send our patient [sic] to another hospital. If and when that happens, we honor the patient’s request,” she said.
All hospitals in this area are required to notify other hospitals when they are on diversion or bypass. They also have to notify EMS providers (ambulance services). According to Mele, the Northlake Campus receives notification from other hospitals they have contracted with for transferring high-level trauma patients. It is also required that any hospital on diversion/bypass, has to provide a four-hour update to all the other hospitals until they come off diversion/bypass.
The Northlake Campus is currently undergoing a state-of-the-art renovation. When the project is completed at the end of this year, they will have 28 rooms—19 in the main department; seven in Fast Track; and two specially-designed to be used by either the main department or Fast Track based on the needs of the patients. There will be two private triage rooms and three trauma bays.
In Fast Track, there is a unique room called a Results Pending Area—this room is designed to allow comfort to patients while they await their discharge instructions.
“It will help accommodate the growing number of patients. The real solution comes from educating patients about their health and how to maintain it. Also, by providing access to physician offices and immediate care centers for health concerns that are not life threatening. Methodist just opened their first immediate care center, Care First, in Crown Point, with other locations coming next year in Merrillville and Gary,” stated Mele.
Currently, there are 269 beds at the Methodist Northlake Campus and 313 at the Southlake Campus. There is no specific number of beds that should be available on a given day, and there is no problem in the area with the number of beds that should be available.
There is no set number of people that have to be in the emergency room before it becomes necessary to declare the hospital at High Census Alert. It is based on a number of patients in the hospitals, wait times in the emergency department and the number of patients waiting to be seen by a provider in the emergency department.
Mele said, “There are many reasons that people come to the Emergency Department. The first is that they receive very good care from the staff. But, there are also health reasons; many very ill, are trauma victims or are referred by their physicians. They may not have a family physician to see. There may be financial constraints. They simply may just not have any other options. Research shows that the number of people requiring hospital care will continue. Having the best processes in place is what is best. There are plans to also increase the number of patient beds due to the expanding population in the area.”