Thursday, April 24, 2014
In the four months MaineGeneral Medical Center’s new hospital in north Augusta has been in operation, all of its patient beds have been full a quarter of the time.
MAinegeneral: The emergency entrance of MaineGeneral in Augusta. The hospital, which opened in November, is at capacity 26 percent of the time, officials say.
Staff photo by Andy Molloy
Hospital chief: Chuck Hays, chief executive officer of MaineGeneral Health.
Staff file photo by Joe Phelan
MaineGeneral Medical Center asks the public to use its Express Care for non-emergency illnesses and injuries, instead of going to the hospital emergency room.
Hospital officials say Express Care can be used by people who cannot see their primary care provider or doesn’t have one, and needs non-emergency care.
MaineGeneral Express Care treats non-emergency illnesses such as:
• cough, colds, flu, sinus problems, sore throat
• ear infections
• nausea, vomiting
• pink eye
• rash and skin irritations, allergies
• sports injuries, sprains and strains
• urinary tract infections
The Alfond Center for Health, MaineGeneral Medical Center’s new regional hospital in Augusta, has 192 beds for patients. The hospital divides the available beds into the following categories:
• 108 for medical/surgical
• 30 for mental health and substance abuse
• 20 for acute rehab
• 16 for critical care
• 14 for obstetrics
• 4 for pediatric
That bed shortage has created a challenge for staff when people come into the emergency room and need to be admitted to the hospital, officials said.
Those patients are placed on hospital beds in emergency department rooms until beds open up on the floors, according to Chuck Hays, chief executive officer of MaineGeneral Health, the parent organization of MaineGeneral Medical Center.
“We move stretchers out into the hall (in the emergency department) and we move an inpatient bed into the room,” Hays said.
The $312 million, 192-bed hospital opened Nov. 9 and replaced inpatient care at MaineGeneral hospitals in Augusta and Waterville, which together had a total of 226 beds. MaineGeneral officials initially had asked the state for 226 beds in the new hospital, but were denied the request in 2010 and it was instead OK’d for 192.
Hays said MaineGeneral officials wanted the higher number of beds because that’s what they expected the hospital’s need to be.
The bed number was set in a certificate of need MaineGeneral received for the hospital project in 2009, a review that was handled by the Licensing and Regulatory division of the Department of Health & Human Services. DHHS spokesman John Martins did not respond to requests for comment Monday on the number of beds authorized by the state.
When the hospital is maxed out — Hays described the bed capacity as being full 26 percent of the time in recent months — officials first asked patients and their families if they want to be transferred to another hospital.
“I would say we’re doing the absolute best we can,” Hays said.
“We don’t want anybody waiting in the ER. It’s about working with patients and their families to make the best decision for them. If they say, ‘I don’t want to go a half-hour away (to another hospital),’we work with them. We said 26 percent of the time it’s been a challenge, to be frank about it, but hopefully, we’re doing what’s best for patients.”
The bed shortage comes as the hospital tries to guide more people toward preventive care — addressing illnesses and injuries with primary care doctors or MaineGeneral’s Express Care service — in an effort to reduce the number of inpatients.
Hays said that when he started at MaineGeneral 19 years ago, 40 percent of its patients were outpatient and 60 percent were inpatient. Now, those figures have reversed.No broader trend
Jeffrey Austin, vice president for governmental affairs at the Maine Hospital Association, said he has not heard of other hospitals in Maine being full as often as MaineGeneral.
“We don’t notice a broader trend of bed availability now,” Austin said. “If there was a general bed shortage, we’d hear about it. Generally speaking, the overall trend is, inpatient admission is down. People are working very hard to keep inpatient admissions down because they’re expense-related.”
But Austin said there is a shortage statewide of emergency room beds for psychiatric patients or those requiring mental health services.
“That is an issue we have heard about for two years across the state being very acute and being a big, big challenge,” he said.
Of its 30 emergency room beds, four at MaineGeneral are reserved for patients with behavioral health needs, according to Diane Peterson, MaineGeneral’s senior editor for marketing and communications.
Austin said dedicating some beds in the new hospital’s emergency room for behavioral health was forward-thinking.
“Most hospitals don’t have that,” he said.
Four beds are also reserved for those who need to be admitted.
Those rooms have solid walls — not curtains — and the patients stay in those beds until private rooms open up, according to Peterson.
All inpatient rooms at the hospital are private, or one-bed rooms.Reading trends
The Augusta hospital has only been open a little less than four months, so Hays isn’t sure if not having enough beds will continue to be a problem.
Hays conceded the matter of knowing how many beds the hospital would need came down to hospital officials and the state predicting the future.
“It’s really hard to gauge trends,” he said.
Hays also said officials are still working out the bugs associated with making the transition from two inpatient hospitals to one — a process he expects to last a total of eight to 10 months.
He surmises that an aging population and a lot of people coming into the hospital with infections and needing to stay longer as inpatients contribute to the reasons the hospital is so often at capacity.
Hospital officials said they hope MaineGeneral Express Care will also help.
Express Care treats people with non-emergency illnesses and injuries such as colds, flu, fractures and sports injuries and is an option for people when they cannot see their own primary care provider, do not have a primary care provider or need non-emergency care.
Hospital officials say they hope that by educating people about their needs and how best to seek treatment, they will find the care they need, leaving the emergency room free to deal with the more serious cases.
Before the new hospital was built, Hays and MaineGeneral’s senior management team and clinical staff traveled to Connecticut, California, Michigan and other areas to visit hospitals that had been through similar transitions.
They asked many questions, including what they would have done differently.
“We learned a lot about what worked for them and what their transition issues were,” Hays said. “We were fortunate to learn from a lot of other people.Amy Calder — firstname.lastname@example.orgTwitter: @AmyCalder17