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Memorial Hermann-Texas Medical Center Works to Improve Capacity Surge Planning

As the Memorial Hermann-Texas Medical Center (TMC) Campus continues to see increased volume, hospital-wide efforts are underway to meet the community’s growing acute care needs through improved capacity surge planning. A team including clinicians, physician leadership and hospital administration meets weekly to re-tool the full-capacity protocol so the hospital can avoid ‘divert’ status whenever possible. ‘Divert’ status occurs when a hospital is at capacity, and EMS is directed to other facilities to prevent overcrowding that may impede the delivery of quality care.

Hospitals nationwide are experiencing patient flow challenges, particularly those with higher acuity, says Toni von Wenckstern, administrative director of the Memorial Hermann Texas Trauma Institute. “Nationally, most hospitals have an admission rate from the emergency department lower than 20 percent,” she said. “Our higher acuity puts our admission rates between 35 and 40 percent, which can make patient flow particularly challenging.”

According to Samuel J. Prater, M.D., medical director of Emergency Services for Memorial Hermann-TMC and assistant professor of Emergency Medicine at UTHealth Medical School, a number of projects to address patient flow in the Emergency Department (ED) have been completed or are in progress.

“We are looking closely at all input, throughput and output processes, from how we manage the front door to how we can get lab and consult results faster,” said Dr. Prater. “There is also work being done to help improve boarding times for an open bed once it is determined the patient needs to be admitted.” As one of only two Level I adult trauma centers, one of only two Level I pediatric trauma centers, and home to the only comprehensive burn treatment center in Houston, Memorial Hermann-TMC experiences a larger proportion of admissions made through the Campus’ ED compared to other hospitals in the medical center.

Tom Flanagan, Memorial Hermann-TMC’s vice president of operations, says the goal of the hospital is to always be available to EMS and the community. According to Flanagan, there are a series of triggers in place to ensure that the hospital’s capacity is at such a level where all patients can be treated safely. While the Campus has an average trauma ‘divert’ status less than one percent of the time, it is still used very judiciously. “Only the senior administrator on duty can approve ‘divert’ status for our Campus; it’s not a decision that can be made by a nursing director or a physician,” said Flanagan. “We realize how difficult it is on our valued EMS partners when we – or any hospital – goes on divert. That’s why we are making patient flow a priority so that EMS can count on us, and the ambulance gets back into service as quickly as possible for those in our community who need it.”