Mayo Clinic staff has had to alter patient discharge plans, whether in length of stay for patients or the facility to which staff has transferred patients. The following are examples of care evolving to meet patient needs: Discharge plan changes Some of these changes addressed preventive care to preclude emergency care needs. She explains that the medical center had to pivot quickly to accommodate as many patients as possible, and booked hospitals led the way for higher care use outside of the facility. Mayo Clinic has learned a great deal amid high census periods in recent months, says Dr. Expansion of services outside of the hospital setting However, she explains that neither the emergency department nor the trauma service has ever been on diversion. While the emergency department at Mayo Clinic often has been full in the last 1 1/2 years, wait times have been longer, says Dr. Loomis indicates this would not affect hospital census. Though demand for preventive care has been robust in recent months, Dr. The population using hospitals' services widened from 30 miles from patients' homes to 60 to 90 minutes from their homes. Where previously the average time to transfer was 5 to 6 days, now transferring a patient to another facility may require 2 to 3 weeks. Medical centers that previously transferred patients after one or two calls to other institutions now must place 10 to 15 phone calls before they locate a facility with capacity, says Dr. Now, average hospital stays are longer, as many hospitals and other care facilities can't immediately take transfers. Hospitals are also experiencing the downstream effects of these factors affecting hospital numbers. Hospitals on diversion, not accepting patients.Difficulty discharging patients, with transfer delays to other facilities due to lower capacity with skilled nursing staff shortages.Patients seeking care in higher numbers than before.This is a trauma care teaching facility.In the past year, several factors have converged to challenge hospital capacity: Level I: This is the highest level, with all the features of level II, plus physician anesthesia and a trauma research program. This is a tertiary referral facility, capable of managing all types of trauma. Extensive specialty services are available, including cardiac, thoracic and orthopedic surgery. 24-hour neurosurgical capacity is required. Level II: A facility which staffs a 24-hour trauma service with at least an emergency department physician, and which maintains a surgeon-led trauma team with rigorous response standards, capable of immediate surgical intervention when necessary. This is an intermediate facility, capable of handling non-surgical trauma. X-ray, laboratory services, recovery room and intensive care beds are required. Level III: A facility which staffs a 24-hour emergency service with at least a physician, and which has general surgical services on an on-call basis. This is a primary referral facility, for rapid stabilization and transfer to definitive care. No surgical or diagnostic services are required. Level IV: A facility which staff s a 24-hour emergency service with at least a “physician extender” such as a licensed physician’s assistant, a nurse practitioner, a registered nurse or a paramedic, with special trauma training as defined by that facility. All levels of a recognized trauma center must maintain a trauma registry and operate quality assurance processes informed by it.
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