Feb. 05, 2022
Though some may point to COVID-19 as the impetus for burgeoning hospital capacity challenges, in fact, a mix of factors has contributed, secondary to COVID-19, says Erica A. Loomis, M.D., a trauma surgeon and the vice chair for practice for the Admission and Transfer Center at Mayo Clinic in Rochester, Minnesota. She also notes capacity issues are common to every U.S. hospital presently — there simply aren't hospitals without capacity problems.
In the past year, several factors have converged to challenge hospital capacity:
- COVID-19 and its variants
- Patients seeking care in higher numbers than before
- Difficulty discharging patients, with transfer delays to other facilities due to lower capacity with skilled nursing staff shortages
- Hospitals on diversion, not accepting patients
Hospitals are also experiencing the downstream effects of these factors affecting hospital numbers. Now, average hospital stays are longer, as many hospitals and other care facilities can't immediately take transfers. Medical centers that previously transferred patients after one or two calls to other institutions now must place 10 to 15 phone calls before they locate a facility with capacity, says Dr. Loomis. Where previously the average time to transfer was 5 to 6 days, now transferring a patient to another facility may require 2 to 3 weeks. The population using hospitals' services widened from 30 miles from patients' homes to 60 to 90 minutes from their homes.
Though demand for preventive care has been robust in recent months, Dr. Loomis indicates this would not affect hospital census.
While the emergency department at Mayo Clinic often has been full in the last 1 1/2 years, wait times have been longer, says Dr. Loomis. However, she explains that neither the emergency department nor the trauma service has ever been on diversion.
Expansion of services outside of the hospital setting
Mayo Clinic has learned a great deal amid high census periods in recent months, says Dr. Loomis. She explains that the medical center had to pivot quickly to accommodate as many patients as possible, and booked hospitals led the way for higher care use outside of the facility. Some of these changes addressed preventive care to preclude emergency care needs. The following are examples of care evolving to meet patient needs:
Discharge plan changes
Mayo Clinic staff has had to alter patient discharge plans, whether in length of stay for patients or the facility to which staff has transferred patients.
Remote monitoring
Tracking patient progress remotely has increased to preempt emergencies. Physicians have expanded use of devices such as glucose meters, pulse oximeters and blood pressure cuffs to use at home by patients. These devices allow health care providers to immediately note data indicating problems.
Advanced care at home
As part of an advanced care at home model announced in 2020, paramedics are now visiting patients at their residences to administer medications.
Video visits
Though available previously, high hospital censuses pushed the use of video provider visits, allowing post-surgical follow-up and consultation about the need for emergency department services to occur outside the medical center's facilities.
Light system
While hospital systems indicating red, yellow or green light census status have been used for some time, these systems have become more robust in the last 12 to 18 months, says Dr. Loomis. She says Mayo Clinic's hospital administration refined the light system definitions and processes, such as a precise definition of red-light status and the means to step down from red-light status.
Admission and Transfer Command Center
The Admission and Transfer Center established a command center for capacity issues, with meetings every morning and evening to discuss status and employable strategies. Some service lines, such as the medical intensive care unit, have been unable to accommodate additional patients on occasion, due to heavy provider caseloads or lack of available beds. To gather data to help balance patient loads, nursing staff members in these offices began daily census and needs reports with sites in the Mayo Clinic Health System, a family of clinics, hospitals and other health care facilities in 44 communities in southern Minnesota, western Wisconsin and northeastern Iowa.
Emergency department triage
With fuller hospitals and emergency departments, triage for patients with emergent medical issues has been refined. Emergency department staff organizes patient cases from most to least urgent.
Transfer processes
Mayo Clinic has further refined its transfer policies. For instance, if an individual calls from Oklahoma about care at Mayo Clinic, Dr. Loomis says staff would ask:
- Does the patient already have a relationship with Mayo Clinic?
- Does Mayo Clinic have something unique to add to this case?
- Will coming to Mayo Clinic benefit the patient?
"We want to make sure patients will benefit from Mayo Clinic care and not take them away from home and family support unnecessarily," says Dr. Loomis.
Dr. Loomis says the Admission and Transfer Center receives calls daily from other countries about seeing patients.
Continuation of new practices
Enhanced or new practices and processes to address hospital capacity over the last 1 ½ years will continue, says Dr. Loomis. "A lot of us will say, 'Oh, when COVID-19 is done,'" she says. "But we don't have that many COVID-19 issues with capacity. Because of full hospitals, we have to work in new ways."
For more information
Anastasijevic D. Mayo Clinic launches advanced care at home model of care. Mayo Clinic.
Refer a patient to Mayo Clinic.