I cant believe what I just read. A 2-page NY Times article on how much better the hosiptals are doing, how filled to capacity they are, how much more reimbursement theyre getting, how much of a profit they are turning over to their investors, how much they are expanding their facilities & how many more beds theyre adding.
NOT A WORD about investing that money to make the workplace one that will attract RNs back to the bedside to take care of all those pts. Notice how the few lines devoted to nurses comments were buried near the end of the article. The nurses part of the interview was censored. None of their logical comments about what are the hospitals doing to recruit & retain to manage the pts in all these new beds were allowed to be printed in the article.
This was sent to me by one of the nurses who was quoted in the article:
<<A flurry of letters to the Times regarding nurse staffing and patient safety might stimulate the editor to respond with a follow-up article focusing on nursing. The writer, Reed Abelson, wanted to do it, but the editor was ambivalent. If he feels there is a lot of sentiment around the issue, it might provoke him.>>
Anybody who would like to know how the hospitals plan to care for the pts in all the new beds theyre adding at the same time they are driving nurses away from the bedsides with unsafe & absuive working conditions is encouraged to write the editor:
The NY TImes
March 28, 2002
Patients Surge and Hospitals Hunt for Beds
By REED ABELSON
(2 page story)
Paul Hochenberg, the executive director of the Long Island Jewish Medical Center, was desperate to find more beds. So last year, as occupancy for his hospital climbed to more than 95 percent, he gave up his own office and his staff's so the hospital could convert the area to a 15-bed unit for patients who were being observed for a day or two.
But the new unit did not solve the overcrowding, and Mr. Hochenberg now plans to seek state regulatory approval for as many as 100 new beds for the hospital, in New Hyde Park, N.Y.
After years in which they closed beds and laid off workers, many hospitals are struggling to cope with surprising increases in the number of patients. Some are being forced to turn away ambulances. At others, emergency room patients who are admitted wait hours or even days for rooms.
What makes the increases more difficult is fewer hospitals
and fewer beds
. Since 1985, the number of hospitals has declined about 14 percent, with the number of beds shrinking 18 percent, the American Hospital Association says. At current levels, hospitals have almost no ability to handle an unexpected increase in patients.
Turning away ambulances was virtually unheard-of last year at North Shore University Hospital, part of the same system as Long Island Jewish. But in the first months of this year, the emergency room was closed to ambulances for 25 hours. "There is no wriggle room," said Dr. Andrew E. Sama, the physician running the emergency department.
At a hospital in California, a man who appeared stable went into full cardiac arrest while waiting to be seen, according to the doctor who treated him. "That's the inevitable result of these delays," the doctor said. The patient was resuscitated.
Hospital admissions are hovering at levels last seen in the mid-1980's. Just over 33 million people were admitted to hospitals in 2000, the latest year for which statistics are available, according to the American Hospital Association. That was up from a low of 30.7 million in 1994.
Outpatient visits have also increased, climbing 16 percent, to 521 million, since 1997. Insurers have long pushed for outpatient treatment. These patients may fill a bed for less than a day while recovering from surgery or receiving chemotherapy. But they are often cared for by the same staff or take up the same beds as inpatients, and are not included in counts of admissions.
When hospitals began cutting beds in the 1980's, everyone from private consultants to government officials was predicting that managed care companies would sharply reduce demand for hospital services by screening requests for care. Some private hospitals in the New York area even tried to fill more beds by having their own ambulances steer patients-particularly patients with health insurance-their way.
But in the last two years, insurers have loosened their controls and now allow more patients to be treated in emergency rooms or overnight. In addition, many people who lost their jobs in the last several months lost their health insurance at the same time and now rely on emergency rooms as their health care providers.
Further increasing demand, aging baby boomers are more likely to experience serious illness or injury, and medical advances are helping doctors treat conditions that patients might have simply accepted in the past.
Experts are divided as to whether the increase in patient visits is a lasting change.
"At this point, we've taken the constraints off the use of care," said Paul B. Ginsburg, the president of the Center for Studying Health System Change in Washington. "We haven't really put in our next mechanism to control use." Demand may again drop, he said, if employers shift more of the cost of going to a hospital onto their employees.
Others think that the increase in hospital visits is continuing a long-term trend that was temporarily disrupted in the 1980's. Gary Taylor, a health care analyst for Banc of America Securities, expects increasing hospital admissions for the next four decades, in line with the increases experienced for much of the last century. Employees are unlikely to pay for a significant share of their hospital care anytime soon, he said, noting how little the average person pays out-of-pocket today.
Some small hospitals still have more beds than they need. But at many others, occupancy levels are soaring, according to the Greater New York Hospital Association's analysis of industry data. Nationwide, hospital occupancy has rebounded to about 64 percent, the highest since 1993. In New York City, occupancy reached 82 percent in 2000 and appears to be climbing.
Yet the averages may not provide a true picture of how crowded a hospital may be: New York-Presbyterian, for example, had an average occupancy of 90 percent last year, but it rose to 102 percent on some days.
Like Long Island Jewish, some hospitals are contemplating adding beds. North Shore is expanding its emergency room, and New York-Presbyterian has applied for permission to expand. Tenet Health Care, one of the nation's largest hospital chains, is expanding at several sites around the country.
As hospitals have merged and gained sway with insurers, many have been able to demand higher payments for the first time in years. As a result, total spending on hospital services increased 5.1 percent in 2000, according to Mr. Taylor, the fastest rate of increase since 1993. Overall spending on health care rose 6.9 percent.
The for-profit hospital operators, like Tenet, are already benefiting from the increased spending, delivering their investors higher profits.
. But many not-for-profit hospitals, which care for many patients who depend on government reimbursement programs, say the payments they are receiving remain below their actual cost of providing care. "Just because you're full doesn't mean you're doing better," said Michael J. Dowling, the chief executive of North Shore-Long Island Jewish, which oversees 18 hospitals.
Given an overall staff shortage, hospitals say their labor costs are rising.
Wendy Z. Goldstein, the chief executive of Lutheran Medical Center Health System in Brooklyn, said that in addition to paying her regular staff overtime, she must also use temporary nurses, adding significantly to costs. "When you're at 98 or 99 percent occupancy, you're losing money," she said.
Nurses are also concerned about the rise in volume.
Judy Sheridan-Gonzalez, a registered nurse who works in the emergency room at Montefiore Hospital in the Bronx, said, "Patients tend to come in a lot sicker, and there's definitely more volume."
She arrived at work one day to find herself responsible for 13 patients. After she protested, another nurse was asked to stay on overtime, leaving Ms. Sheridan-Gonzalez with seven patients. One of them became critically ill and had to be rushed to the operating room. "I could have easily missed that," she said. Montefiore declined to comment.
Earlier this month, Mary E. Foley, the president of the American Nurses Association, testified before Congress that nurses are increasingly worried that inadequate staffs threaten patient care.
In a survey last year, three-quarters of nurses said the quality of nursing care where they worked had declined over the last two years.
Many hospitals are closing their emergency rooms to ambulances when they do not have enough beds or nurses to provide adequate care. For about 12.5 days out of every month, Piedmont Hospital in Atlanta has to ask ambulances not to bring some patients to the hospital, sometimes for two to three days at a stretch, said Steve Taylor, vice president for medical services.
At Brooklyn Hospital Center, emergency room patients were waiting more than two days for beds last year, according to Frank J. Maddalena, the hospital's chief operating officer. In January, to handle the higher volume, the hospital reopened 19 beds and may open more.
Many for-profit hospital systems are able to respond quickly to the surge in demand by expanding. Tenet, for example, is adding 80 new beds at Delray Medical Center in Florida and expects to have no trouble filling the beds in a new 10-story tower at USC University Hospital in Los Angeles.
"We just don't have the capacity," said Thomas B. Mackey, Tenet's chief operating officer.
A 2002 industry study concluded, "After 10 years of downsizing in the 1990's, hospitals are making new building plans." It predicts that hospitals could spend $5 billion in new construction over the next five years.
The report was issued by the Society for Healthcare Strategy and Market Development, a unit of the American Hospital Association, and other industry groups.
Some not-for-profit hospitals are also adding beds, although finding the money to expand is more difficult. In Naperville, Ill., Edward Hospital is in the middle of a $45 million project that will add 71 beds. American Fork Hospital in Utah just completed a $32 million expansion, including about 20 more beds.
In the New York area, the Saint Barnabas Health Care System is considering adding beds at three of its hospitals, including its namesake in Livingston, N.J. Occupancy there averaged 89 percent last year and went as high as 95 percent.
Many hospitals are trying to operate more efficiently, discharging patients more quickly when possible. At Lutheran Medical in Brooklyn, the average stay in the medical-surgical units has been reduced by a full day, and administrators hope to get it down by another half-day, to around six days.
But many hospital executives say they are struggling to come up with solutions.
"We're really kind of up against it," said Herbert Pardes, chief executive of New York-Presbyterian. "It's a real dilemma."