Capacity Management

As the Omicron surge hit, BH started dealing with a crisis in capacity. Initially this was related to sheer numbers of COVID-19 cases and their tendency to have longer lengths of stay than elective patients.

As we emerged from Omicron, however, the effect of workforce shortages began to take over as the prominent driver. Low levels of staffing in nursing homes and home care agencies made discharges to those facilities a challenge. For the final nine months of 2022, BH ran an inpatient census of 1,100-1,200, a full 10-20% over its licensed bed capacity. At times, some of our community hospitals exceeded even that level, notably Baystate Wing Hospital in Palmer, which reached 150% of licensed capacity.   

A wide variety of initiatives were quickly brought online to deal with the crisis. Care management services were reorganized under the Chief Quality Officer, and a Medical Director for inpatient throughput assigned. Protocols for early discharge were enhanced, and in-hospital care navigation programs expanded, resulting in reduced lengths of stay without increases in readmissions. A program of direct to operating room transfer (bypassing the ED) was initiated for selected surgical specialties, and the transition to same-day joint replacements accelerated. Changes in the ED itself included huddles at each shift, regular leadership rounds, an enhanced fast track system, and regular rounding on patients in the waiting room to ensure stability. Probably the most impactful intervention was the implementation of a Daily Management System, included in the Highlights section of this report. Tiered huddles led to broad based situational awareness and more rapid problem solving. Even with all these interventions, which have made material improvements in length of stay and patient safety, demand for emergency and inpatient services continues to outstrip supply and will require ongoing efforts to manage.

One particularly challenging area of supply/demand mismatch is behavioral health, which has become a national crisis. The demand for behavioral health services has surged nationwide in the wake of the pandemic, attributed to prolonged isolation and a lack of normal social activities. These stressors have led to increased assaults on healthcare workers and unprecedented demand for behavioral health services. Each week, between 500 and 700 patients are waiting in EDs across the state for an inpatient behavioral health bed to open; many, particularly children, must wait many days and even weeks. BH has helped to lower demand for inpatient services by embedding behavioral health providers in all its practices before the pandemic, enabling earlier interventions.

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