‘Capacity alert’ plan coordinates best use of hospital beds

‘Capacity alert’ plan coordinates best use of hospital beds

It's become almost a new norm: Unprecedented high volumes of patients are keeping the University of Mississippi Medical Center hospitals at or near capacity, sometimes pushing demand for beds, staffing and other medical resources beyond what's available.

Administrators have a plan to manage the transfer of patients from other hospital emergency departments to UMMC's Emergency Department and the transfer of inpatients from other facilities to the Medical Center's 406 critical care and medical-surgical beds. When beds are full or expected to be full given scheduled admissions and transfers, a “capacity alert” will be declared.

Patients waiting for a bed are considered boarded, meaning they're being temporarily cared for in another hospital location rather than a regular patient room.

When a capacity alert is declared, an email message will be distributed to multiple departments, including providers, leadership and MedCom. Newly created Medical Control Officers, or MCOs, will lead the decision-making on transfers requested by another hospital's ED or inpatient physicians.

The Medical Center's ED physician on duty will act as an MCO, coordinating with MedCom requests for emergency transfers. An MCO appointed in collaboration between administrators and medical staff leadership will evaluate requests from other hospitals to place inpatients in the adult hospitals or ICUs.

“We want to accommodate all patients who need the level of care provided by this facility that might not be provided anywhere else,” said Trish McDaniel, the adult hospitals' chief operating officer. “When we're on capacity alert, we've either met or are fast approaching our ability to do that.”

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Acid reflux procedure eases years of pain

Beginning when he was 27, life for the Rev. Earl Reyer was dictated by just how bad his acid reflux and spasms were that day.

“I lived in fear,” Reyer, a Bentonia resident who's now 61, said of pain caused by esophageal spasms so severe they're sometimes mistaken for a heart attack. “When you're a pastor, those short casket funerals are tough. You're standing there representing God, and all the time I'm dealing with stomach issues and reflux and hoping I don't have a spasm in the middle of a service.”

More than three decades and a plethora of medications later, Reyer took a leap of faith. He recently became one of the first patients at the University of Mississippi Medical Center to undergo a procedure using the LINX® reflux management system. It keeps stomach acids from traveling up the esophagus and causing gastroesophageal reflux disease, or GERD.

Generally referred to as reflux, GERD affects 20 percent of the population. It's caused by a weak muscle in the esophagus that allows stomach acid to enter the esophagus and cause chronic inflammation. GERD sufferers typically have burning pain in their chests and throat, trouble swallowing, and the feeling of food sticking rather than being properly swallowed.

The worst cases can put a patient at risk for esophageal cancer and chronic pulmonary disease. In Reyer's case, the ever-present acid also permanently damaged the enamel on his teeth, caused him to curtail travel, and left him sleeping upright in an easy chair. “Reflux took the joy out of my life,” he said. “It takes the icing off the cake.” 

After undergoing back surgery last fall, Reyer just weeks later was treated for blood clots in his lungs. “I couldn't get my breathing back,” he said. “I went to the UMMC emergency room. They thought the reflux was affecting my air passages.”

He was referred to Dr. Pierre de Delva, an assistant professor of cardiothoracic surgery and a specialist in reflux and swallowing problems. De Delva told him about the options for treating GERD, Reyer said.

Reflux sometimes can be managed by lifelong medications, de Delva said, but severe cases can require surgery. The standard operation has been Nissen Fundoplication. That surgery can be done laparoscopically and involves wrapping the upper curve of the stomach around the esophagus. The lower portion of the esophagus passes through a tunnel of the stomach, creating a new barrier to reflux.

Only about 1 percent of GERD sufferers end up being referred for that procedure, de Delva said. “About 60 percent are well controlled on medication, but there's a gap of patients who aren't. Providers aren't ready to refer them for surgery because of the perception that the side effects of a Nissen aren't worth it, and because reflux isn't life threatening.”

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Acid reflux procedure eases years of pain

People of the U: Dr. Lishia Lee and Dr. Josie Bidwell

People of the U: Dr. Lishia Lee and Dr. Josie Bidwell

Listening to the banter between Dr. Josie Bidwell and Dr. Lishia Lee as they each roll fondant icing into the shape of cats, you'd never guess that when they first started working together they didn't really like each other.

“We hated each other,” said Lee, an assistant professor in the traditional BSN program at the University of Mississippi Medical Center's School of Nursing.

“I thought she was mean, and she thought I had an attitude,” said Bidwell, who is also an assistant professor at the SON, as well as newly appointed director of the UNACARE clinic in Jackson. “We were both correct about that.”

“Yes, we were,” said Lee.

“Once we started working together, we realized we kind of liked that about each other,” said Bidwell.

Lee was the nurse educator on 4C at Batson Children's Hospital when Bidwell first started working there as a new nurse. They both still fill in as floor nurses on 4C as needed, along with their duties as SON faculty.

The collaboration taking place between Lee and Bidwell in the kitchen located on the second floor of the SON building had little to do with nursing, aside from the fact that the cake they're decorating is for fellow faculty member, Mary McNair, who defended her dissertation on the following day.

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Field lectureship, Mayo Clinic expert's talk highlight week's schedule

A number of interesting events is scheduled for the upcoming week at the Medical Center.

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Field lectureship, Mayo Clinic expert's talk highlight week's schedule
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