BWH Tackles Diversion Issue- BWH Bulletin - For and about the People of Brigham and Women's Hospital
BWH Tackles Diversion Issue- BWH Bulletin - For and about the People of Brigham and Women's Hospital
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December 8, 2000
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In This Issue:
Bretholtz Center Opens
The Gift of Time
BWH Tackles Diversion Issue
HR Is Moving
Happy 100th Birthday, Faulkner
Obituary: Sonia Terk
Who Says Three’s A Crowd?
Fun with Friends
Are you ready for JCAHO?
Pike Notes
Emergency Department (ED) diversion at Boston hospitals has become a hot topic recently in the mass media. Many people have raised questions about how this problem can be effectively tackled when so many of the area’s hospitals are operating at nearly full capacity levels on such a consistent basis. However, says Ron M. Walls, MD, chairman, Department of Emergency Medicine, BWH is taking several crucial steps to ensure that the care and safety of all patients remain at their highest standards. “The Department of Emergency Medicine does everything it can to avoid diversion,” said Walls, noting that BWH’s diversion hours declined in 1998 and 1999 but increased in the summer of 2000 when some Tower beds were being reconfigured. “The new ICU beds coming on line and the reopening of the closed Tower pods will help considerably.” At certain times, the hospital’s occupancy is too high, and admitted patients in the ED must wait several hours for Tower beds to become available, which can dramatically decrease the ED’s capacity to care for incoming patients. When the situation reaches a breaking point, BWH can request a two hour period of “diversion” from Boston EMS, which results in all non-critical ambulance patients being diverted to the nearest appropriate facility. Even during these times, however, major trauma patients or those in extremis—such as cardiac arrest—are never diverted from BWH. Walls adds that BWH’s merger with Faulkner Hospital has provided an important resource. “In order to meet patient demands, BWH’s key growth strategy is to admit increasing numbers of patients to Faulkner Hospital, which has a significantly unused capacity. BWH primary care physicians are already admitting patients to Faulkner, and many patients are transferred each week from our ED directly to an inpatient bed there. Plus, the relocation of a large number of Harvard Vanguard patients to the Faulkner ED and inpatient units beginning in January 2001 will further increase BWH’s capacity.” “Patients who need major procedures or significant specialty treatments must be seen in a timely fashion at our facility. In order to do this, patients who can be treated at Faulkner should be evaluated and admitted there,” said Robert C. Goldszer, MD, Director of Specialty Services at BWH. “Prevention of problems and evaluations in our offices is a primary strategy. Having excellent access and communication for our patients will help decrease ED visits.” Said Anthony Whittemore, MD, chief medical officer at BWH, “The hospital is committed to reducing the number of hours on diversion, a number which increased last year, along with a 10 percent increase in ED visits to nearly 55,000 per year.” “The Department of Emergency Medicine is working with admitting departments—including Medicine, Surgery, Neurology and Orthopedics —to improve the admission process through the ED and shorten length of stay, especially when the ED reaches its capacity for patients,” said Walls. “The flu season will tax our resources even more fully this winter, and we would urge primary care physicians to use the Faulkner ED for appropriate cases, immunize all patients as indicated, and help patients to develop reasonable expectations regarding possible waits for care in the ED. I think it is also important to recognize the extraordinary efforts of the physicians, nurses, and other ED staff, who work so hard around the clock to provide top notch emergency care to our patients in a very challenging time.”