Once my husband was admitted—not for an emergency but for an unscheduled, important inpatient test—one night to the cardiac service in a hospital where I had worked.

There was a long delay once he got into the room.  He asked what the problem could be.  This was not like them.

“They are jammed to the rafters and over-flowing. We need to be a little patient. They’ll get here,” I told him.

“How in the world do you know that?” he asked.

I just knew, I said. I can read this hospital’s pulse as well as my own. Trust me on this. They’re having a hard time tonight. Stay cool.

When the nurse arrived to take him for the test, my husband said, “May I ask you a question. How full is this hospital tonight?”

She threw her hands up in frustration. “You can’t begin to understand. We’re are so far past peak I don’t know what to call it.”

After that, my husband said, “Tell me how you knew this.”

I didn’t know but he pressed. Ever the journalist, he insisted I answer. This intrigued him.

“Well, the guerneys are all being moved as fast as possible. That is only true when the place is packed. Usually the patient is transported proportionate to the speed needed for their condition, more or less. This is not written down. It is just how people work. When every guerney looks like it is for an emergency, I figure that means something.

“It also is in their eyes. These people’s eyes telegraph to me, ‘We are up against the wall here.’ Let’s say you were at the newspaper. The presidential election had been that day and you get a call that the presses are not working right—and the paper was going to be very late getting out. What would your eyes look like? It’s kind of like that. You know your culture. I expect another health care person could walk in here tonight and make the same guess. It is not witchcraft.”

Also, this is one of American’s busiest hospitals and so, perhaps, it is easier to take its pulse than it would be in others.

This hospital takes its own pulse very well, too. They really scramble to make up for a bunch of big surprises but the fact remains that even here, they have to scramble.

Their morbidity and mortality outcomes show that they scramble effectively—their outcomes tend to be very, very good to excellent.

An excerpt from Dr. Pauline W. Chen’s column, Doctor and Patient, below, is about this issue.

What happens when a hospital hits its own threshold for being a risk to the patient? Too full? Understaffed? Weekends? Season (winter is worst)?

A new study shows what many experienced health care people know intuitively.

Each hospital has its own measure of what our-backs-are-against-our-own wall. The risks to patients vary in proportion to those four problems.

The New York Times

…”Analyzing the records of almost 40 hospitals and nearly 175,000 patients, researchers at the University of Michigan in Ann Arbor found that four factors — high hospital occupancy, weekend admissions, nurse staffing levels and the seasonal flu — can affect a patient’s risk of dying in the hospital. But while these factors universally influence in-hospital mortality, they can also interact with one another in such a way that each hospital ends up with its own particular threshold of risk. (Emphasis added)

“The key is identifying not some universal cutoff point, but an individual hospital’s limits. (Emphasis added)

“These patterns are as individualized as fingerprints,” said Dr. Matthew Davis, an associate professor of pediatrics, internal medicine and public policy at the University of Michigan and senior author of the study, published in the journal Medical Care. “There is an optimal balance that is different for each hospital.” Ideal nurse-to-patient ratios, for example, can vary depending on the patient populations served. Similarly, a hazardous level of occupancy might be 70 percent for one hospital and 90 percent for another.

“But unlike our fingerprints, a hospital’s limits can change. During flu season, for example, hospital staff can decrease their patients’ mortality risk by getting vaccinated. Hospitals can also shift the schedule of elective admissions to free up beds and hospital staff for admissions from the emergency room. “Understanding these vulnerabilities in a hospital system can pay very big dividends,” said Dr. Peter L. Schilling, lead author of the study and a resident in orthopedic surgery at the University of Michigan.”

Source: New York Times, March 19, 2010