Since the summer of 2016 we have experienced higher-than-anticipated numbers of patients seeking care in our hospital. These higher numbers have continued for longer than expected. This may come as a surprise to our patients, their families and our community partners.
Our number one priority is to provide the highest quality care to every patient who enters our doors. This is our mission and it’s what is at the center of all we do. During this period when more people are seeking our care, we want our community to understand what is happening and how it may impact you. Most importantly, we want you to know what we are doing to maintain the highest quality care for our patients as we work through this complex challenge.
On average, we are caring for an additional 34 patients per day – approximately equal to one additional medical/surgical inpatient unit. This sustained increase is not expected to go down in the near term, and so we must treat it as our new normal.
Our dedicated staff and leaders have all personally risen to the occasion to ensure safe staffing levels and patient care has not been compromised. That said, this situation impacts the experience of our patients when they come to us for care. It also puts a strain on providers and staff at all levels who are caring for more and more patients.
We have continued to monitor the situation closely and determined that there are a few key drivers for the increased number of patients needing care in our hospital. They include:
- We have seen an increase in demand for hospitalization for our aging Medicare patients, particularly those from Chittenden County.
- Our length of stay is up, in part due to challenges finding facilities to which we can transfer patients who no longer need hospitalization but still need ample support to aid their healing.
- We have had an increase in the number of patients requiring isolation. This is challenging because it prevents us from caring for patients in the second bed in double rooms – the majority of our inpatient accommodations.
- We have also had an increase in the number of patients seeking mental or behavioral health care. Many of these patients require ongoing accompaniment or observation for their safety. This is a statewide mental health care challenge. On any given day, UVM Medical Center can have between two and 20 patients in a mental health crisis staying for extended periods in our Emergency Department. This situation is not in the best interest of those patients who require care in a more therapeutic environment.
Providing a great experience while receiving care at the UVM Medical Center is a responsibility we take seriously, for patients in our local community as well as patients across Vermont and northern New York whose providers refer them to us for their care. We do anticipate surges in our patient numbers from time to time – for example, during flu season – but not for this long. We rigorously analyze past patterns and trends to make projections on patient volumes that impact decisions we make, including staffing decisions. We are facing this challenge openly and directly with our teams and are focusing our collective energies on solutions for our patients and our staff.
This strain is not sustainable for the long run. We are implementing near- and long-term solutions to ensure that high-quality care and adequate staffing levels are maintained.
Near-term strategies have included hiring more staff, increasing the number of qualified nurses hired on a temporary basis, and training and deploying several dozen nursing students from the UVM College of Nursing and Health Sciences to provide observation for lower-risk patients. Under the leadership of the Jeffords Institute for Quality and Operational Effectiveness, teams are working on strategies to make admission and discharge processes more efficient and getting patients where they need to go more quickly, freeing up beds for patients who need them.
A longer-term strategy as we continue to develop the UVM Health Network is to keep hospitalized patients closer to home in their local network hospital where appropriate.
Caring for our neighbors living with mental illness will be an ongoing need at the UVM Medical Center. We are actively engaged with our partners across the state on solutions to address this crisis. That work will take time, but we are fully committed to it.
We are hiring the additional permanent nurse and licensed nursing assistant positions needed to close the gap created by the sustained patient volumes. In the process, we are creating stronger partnerships between leaders and frontline teams to implement new strategies together. This will allow us to rely less on the temporary solutions we have used thus far.
This has been a challenging time for the UVM Medical Center. Each of us has been asked to give more to tackle these complex challenges. We believe in transparency and openness, even when the issues are difficult. All of us, no matter the practice area or department, are united in our commitment to our patients and this community. That shared purpose will carry us through to meet this challenge.
We will keep the public and our teams informed of our progress as work continues.
Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, is chief nursing officer at the University of Vermont Medical Center.
Steve Leffler, MD, is Chief Medical Officer at the University of Vermont Medical Center.