As a hospital-wide Quality and Safety goal for 2019, improving institutional capacity helps our local and regional patients receive the MGH expertise and services in a timely manner. Using a team-based approach, many role groups and committees are working to integrate capacity management into the daily workflow.
Inpatient Capacity Initiatives
The Capacity Operations Committee organizes and oversees all inpatient capacity efforts, including:
Bed reallocation – Computer modeling simulates and optimizes the right number of patients for each service, which helps minimize patients admitted to service that differs from their diagnosis and maximizes hospital capacity. The team will complete the rollout in the fall.
Direct Admit – this work creates a standard pathway for outside hospitals to admit patients from their ED directly to MGH inpatient locations, bypassing the MGH ED. The group started the pilot for trauma patients and will expand to new diagnoses in the coming months. These include: burn, aortic emergency, subarachnoid hemorrhage, new brain tumor, large vessel occlusion, and patients who had complications after a procedure at MGH.
Discharges – Although challenging, timely discharges help relieve daily inpatient congestion. The Capacity Operations Committee calculated the gap between bed requests for each inpatient unit and the number of open beds by hour of day. They found that most inpatient units need to discharge 1-2 patients before 11 am to close this gap, which would ease ED, ICU, and PACU congestion. The process improvement team, nursing, case management, and physician leadership developed a new workflow to achieve an 11 am discharge. Six internal medicine inpatient floors and 2 general surgery floors have implemented the workflow and observed significant increases in morning discharges.
The Capacity Physician Role and How All Physicians Can Help
The capacity physician works with Admitting, Patient Access Services, and nursing triage supervisor teams to help address both the daily and systemic capacity challenges. The capacity physician acts as a resource to help with complicated hospital transfers and patient placement challenges, physician communication issues, and barriers to patient progress of care.Physicians who need to admit a patient and find the usual channels are not working can contact the capacity physician 24/7 through the page operator, Capacity MD, or pager 23556, or via email CapacityMD@MGH.harvard.edu.
Keep Patients Out of the Hospital
Mass General supports a range of services that provide alternatives to the ED and hospital admission, including the Mobile Observation Unit and Home Hospital.
