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MGH continues to grapple with patient overcrowding

Five years after expansion, problem returns

Dr. Peter Slavin, President of Mass General Hospital. Barry Chin/Globe Staff

Massachusetts General Hospital is struggling with an overcrowded emergency department less than five years after it sought to fix the problem with a $500 million expansion.

In a staff memo Monday, MGH president Dr. Peter L. Slavin said emergency medicine is at capacity almost every day, leading to “delays, dissatisfaction, and sometimes even concerns about quality and safety.”

Visits to the emergency department at the state’s largest academic medical center have increased by 18 percent since 2010, Slavin outlined in his monthly memo, and now top more than 100,000 a year.

In addition to general demand, more patients are coming in for high-intensity, complex care that ties up beds longer, said Sally Mason Boemer, MGH’s senior vice president of finance. The hospital is also seeing more patients arrive from many areas outside of Boston.

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A lack of available beds forced 80 percent of all patients last year to wait in the emergency room for varying periods of time.

The crux of the problem is 30 to 45 unused beds in shared rooms at any given time because of issues ranging from an inability to match patient gender, to an unwillingness to pair a patient in a room with someone suffering from a disruptive mental health issue, Mason Boemer said. This, combined with an increase in patients, thrusted MGH back to its preexpansion dilemma.

“One of the clear lessons learned is the value of single rooms,” she said. “There were more demands than we anticipated.”

In the year following the addition of 100 beds, there was a “brief moment of relief,” but logjams began to creep up again in 2014, Mason Boemer said.

In the course of a year, MGH experienced a staggering 164 percent spike in the number of instances that the emergency department reached “code help” or “capacity disaster” status. The codes are activated after emergency departments are filled with a certain number of patients who have been admitted but have not been assigned a bed.

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And overcrowding isn’t just affecting the emergency department. On a daily basis the state’s largest teaching hospital is between 95 and 100 percent full at peak times, such as midday.

“We know we must ramp up our efforts to provide efficient care — care that is safe, appropriate, and timely,” Slavin said.

To address what Slavin calls an “escalating situation,” a task force comprising hospital leaders was formed and charged with coming up with immediate and long-term solutions.

The task force is divided into three groups focused on reducing the demand for beds; working to reduce patient readmissions; and identifying internal issues that may contribute to the gridlock.

“This is an institutional problem, not an emergency problem,” Mason Boemer said. “I wouldn’t be doing this task force if I had those 30 to 45 beds.”

The hospital, part of Partners HealthCare of Boston, has also tapped the Massachusetts Institute of Technology for management expertise to help the groups determine whether their proposed solutions will work. Slavin said those recommendations could come in a few months.

Slavin’s comments come just as Boston Children’s Hospital administrators are in the midst of seeking approval from state officials to build a 575,000-square-foot facility at its Longwood Avenue campus specifically due to a lack of capacity.

At a hearing before state public health officials last week, Children’s chief executive Sandra L. Fenwick said that hospital’s young patients are experiencing increasing wait times due to overcrowding, with many spending nights in the emergency room.

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Backup issues are plaguing emergency rooms in hospitals nationwide, said Caroline Steinberg, vice president of trends analysis for the American Hospital Association, a national advocacy group.

From 2000 to 2014, the number of emergency room visits nationwide increased by about 40 percent, even as the number of emergency departments declined, Steinberg said. Hospitals recorded 31 million emergency room visits in 2014, up from 22 million in 2000.


Katheleen Conti can be reached at kconti@globe.com. Follow her on Twitter @GlobeKConti.

Correction: Due to incorrect information provided by the hospital, an earlier version of this story misstated one source of overcrowding of the emergency department. It is from an increase in patients from areas outside of Boston.