By NHRMC President and CEO, Jack Barto
The last few months at New Hanover Regional Medical Center have created a “new normal” in how we think about patient volumes, and once again reminded us how thankful we are for the teamwork and cooperation of our community medical staff.
For the past nine months, and especially in recent weeks, our patient volume set records almost every week. As a normal course of business, we now typically take care of a daily census of more than 600 inpatients – a number unheard of here just a few years ago and one that just 12 months ago would have necessitated some level of crisis management.
Today, this is our baseline business day. We can safety provide high quality care to more patients than before – with a great deal of help from our medical staff and our own frontline staff.
Most of this trend is the byproduct of something we are very grateful about, which is that more of you are choosing New Hanover Regional Medical Center as your hospital. As our community medical staff has grown more proficient in many specialties, our services have improved. Patients no longer feel the need to leave the area for services such as cardiac, oncology, neurology or pediatrics, and patients in surrounding counties are more likely to choose us for care. Those of you in New Hanover County remain as loyal as ever, as our county market share remains at 94 percent.
For all this we are very blessed and appreciative. All our community’s physicians, and all the clinicians and employees at NHRMC, have worked very hard for this trust, and we are grateful for the opportunity to serve you.
Add in a few more factors – an unusually strong flu season (though that hasn’t driven patient volumes as much as you might think), the aging of our population and the overall population growth of this region – and you have “problems” that many hospitals would envy.
We have responded with a variety of tactics. We have opened every bed that the space in our 10 floors at the main hospital campus will allow. We have added RNs and other support staff, and continue to hire more as these trends continue. And we have batched patients from the same medical practice on the same floor whenever possible, so physicians from those practices can more easily round on all their patients, help cover for each other, and sign discharge orders for their partners when appropriate.
This brings us to our partners in the physician community. They accepted that we needed their help to move patients through the system, and responded to the call. When we first called a “Code Lavender,” which means we have a number of patients waiting for beds, and later a “Code Purple” when our census reached the once-unthinkable 686, our physicians and staff worked together to remove barriers to patients going home.
We emphasized safe and appropriate discharges, and have every reason to believe that’s exactly what happened. Our rate of patients who readmitted within 30 days for December 2014 was not appreciably different than the year before, suggesting that patients were being discharged appropriately.
Finally, much of the credit goes to our patients and their families, who worked with us during the times of particularly high census and were patient and understanding throughout. Everyone pulled together during our peak levels.
Going forward, we think we have a few more strategies to help us remove barriers that delay patients from moving appropriately through the system. Our nurse case managers, who help plan safe and effective discharges for our patients, are rearranging their schedules to work weekends, so that after-care planning keeps moving forward at all times.
And our SharedCare model of nursing, which provides a team approach to nursing rather than having all discharge duties falling to the same nurse, will continue to help streamline patient care going forward.
As health care moves in the near future toward models of preventive care, wellness and population health, rather than treating patients after they become sick, all hospitals are going to have to adjust to a time when the beds are not filled. In fact, that will become the goal.
We are no different, and we are preparing for new care models centered on population health by taking our care beyond the walls of the hospital. But, as our recent experience shows, that day is not here yet. And we are very thankful we can count on a skilled and professional medical staff and a dedicated team of employees to ensure the most important thing we do – take care of our patients – remains constant even as our numbers grow.