The care of all patients in the BH system was affected in dramatic ways by the pandemic and its attendant staffing shortfalls.
Patients deferred routine care for chronic illnesses, such that the severity of disease of those presenting for care was increased. Staffing shortages in nursing homes caused them to run under capacity, making discharges from our hospitals to those facilities delayed and difficult. The need to wear protective equipment, cohort patients with respiratory illnesses, and await COVID-19 test results for patients, slowed the flow of patients throughout the system. An increase in patients with behavioral health conditions, particularly children, strained a system that was already undersupplied with inpatient behavioral health beds. Boarding of patients in our Emergency Departments (ED) awaiting placement in a psychiatric setting more than doubled in 2021, leading to a reduction in the effective number of emergency room bays. This caused long waits for care, frustrating both patients and providers alike. Reductions in patient flow and increases in demand were felt across the system during the fourth surge. Licensed for 980 beds, the hospitals of BH at times cared for 10-20% more than that number. This meant that patients waiting for beds were forced to hold in surge spaces and in the Emergency Department.
Under the leadership of Dr. Doug Salvador, BMC Chief Medical Officer and BH Chief Quality Officer, a capacity management command center was stood up. Several new capacity dashboards were fed by a comprehensive bed management software implemented last year called Teletracking. This led to better coordination across the system between physicians, nurses and staff in the EDs and inpatient floors. Additional resources were brought to bear in Hospital Medicine and Care Management at BMC, particularly on nights and weekends. A multidisciplinary group advanced projects to accomplish a greater number of early morning discharges by eliminating barriers such as testing, imaging, and specialty consultation. Projects to improve timing for patient transport and room turnover by environmental services came online. New home care programs have allowed for earlier discharges as well, particularly for COVID-19 patients who are in recovery. Care management has been intensified for patients with complex social issues and long lengths of stay. In the BMC ED, projects to reduce imaging times were put in place, and a Rapid Medical Evaluation program supplemented the Fast Track system to allow for the treatment and release of patients with minor illnesses, without moving patients into standard ED bays.
For Behavioral Health, the area of greatest increase in demand, a separate Incident Command team was set up under the leadership of Dr. Barry Sarvet, Chair of Psychiatry. The group helped to maximize the use of BH’s own behavioral health beds, expedite connections to behavioral health hospitals and ambulatory programs across the state, and increased placements in foster care arrangements. The group has escalated its concerns and gotten the active involvement of the Massachusetts Commissioner of the Department of Mental Health and other social service agencies.