A Full Hospital

It's a tricky situation. Ideally, a hospital wants to run at perfect capacity. By filling every single bed and controlling all the patients going in and out, it can run with maximum efficiency, caring for the most people, generating the most revenue. But this is never the case. A hospital can't predict how many patients are going to come through the emergency room or be sent from clinic as a direct admit. And though we try, it's also difficult to predict when a patient will be able to discharge home. There are unforeseen complications that send a patient up to the intensive care unit or changes an outpatient surgery to an overnight admission. And this affects resource management as well. How do you staff a unit when a new admission might come at any time? How do you avoid keeping unneeded bodies around but have enough capacity to meet surges of demand? I see this often on labor and delivery. Sometimes, there are extra nurses around to give a hand because the census is light. A few hours later, after a few patients arrive, it's all hands on deck and the charge nurse starts worrying about having to call more people in. These are the concerns of a hospital administrator. If you run too much below capacity or pay too many people to stick around "just in case," you'll lose money. But if you miscalculate, then suddenly you might have a queue of patients building in the emergency department or PACU, awaiting beds.

These past few weeks, the hospital has been running at capacity. I've definitely noticed it in the operating rooms and the intensive care unit. Cases get delayed because it's not clear that when the surgery finishes, the patient will have a bed in the hospital. Pressure is put on the intensive care unit to send patients to the floor and free up needed rooms. Charge nurses struggle to figure out how many extra people to call in. Everyone's tired; the delays make us cranky, and we wonder why we're spread so thin. But I simply remind myself that I am here to take care of patients; I focus on that, and let the administrators work out the stresses in the system.