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Shifting Patient Volume: Mitigating the Need to Build by Maximizing System Resources
A 10+-campus healthcare system was experiencing significant inpatient capacity constraints at their flagship hospital while their other large hospital located three miles from the flagship had sufficient capacity. Before building additional inpatient beds at the flagship hospital, the health system wanted to better understand future growth and whether that growth could be absorbed by or shifted to hospitals in the system. In addition, the health system wanted to bring prominence to its children’s hospital, including expanding the ICU. The client engaged Catalyst to evaluate the existing conditions and future bed need as well as assess whether beds needed to be added in the ICU.
Catalyst developed a master plan focused on inpatient analytics, capacity, and constraints. We created several tools to help our client better understand census trends, where capacity constraints will likely occur, and opportunities to shift volumes or improve upon targeted operational metrics. In this engagement, which has been ongoing since 2015, we do a deep dive several times a year on:
- Patient origin
- Historic trends
- Bed need by type by service line
- Bed occupancy by unit
- Semiprivate bed utilization
- Impact of privatization
- Impact of shifting volume between campuses
- Impact of operational improvements
- Impact of opening, closing, or renovating inpatient units
First, we provided an overview of operational stats by campus and service line, adjustable by year and quarter to review historical trends in volume, ALOS, and patient days. From this high-level overview we then reviewed Average Daily Census (ADC) trends to better understand campus and unit utilization rates as well as historical fluctuation. ADC was tracked across hospitals as well as by unit and bed type to evaluate occupancy across adjustable time periods. Both tools assist in understanding historic census as well as how volumes can be shifted to accommodate units (and campuses) experiencing high occupancy. We also reviewed ADC histograms to track utilization of the campus and individual units, providing a snapshot of overall utilization as well as frequency of peak utilization (above 85%/90%).
On the children’s hospital side, we examined data on the feasibility of adding ICU beds or converting medical/surgical beds into ICU beds.
Based on physician preference, the health system planned to add 12 ICU beds to the children’s hospital. However, after reviewing our findings and recommendations, they decided to add just six beds, eliminating the need for a multimillion-dollar investment in a new inpatient tower.
Given the client’s preference to mitigate build, we focused our findings and recommendations on identifying operational efficiencies and shifting volume between campuses. We found that the system has enough beds for current and five-year projections, but the supply of beds was misaligned. More services, such as labor and delivery, orthopedics, and cardiovascular, have been shifted to the newer hospital. Also, instead of building new space we recommended that underutilized space be repurposed to add capacity for services that have a higher volume of patients.
Urban Medical Center
Service Line Rationalization