Data support MIT Medical's proposed community care model

March 4, 2010

Concurrent with national changes in how health care is provided, overnight use of our Inpatient Unit has declined dramatically. As the chart below shows, the number of admissions, number of patient days, and the occupancy rate have all declined in recent years. In 2005, the unit cared for an average of three to four patients a day. In 2009, the unit averaged between one and two patients per day.

During the same period, there was a doubling in the number of transient (non-overnight) visits to the unit for treatments and other types of supportive care, such as as intravenous fluids for hydration, intravenous antibiotics, and the use of medications that require infusion and careful monitoring for up to several hours.

Inpatient Unit — utilization:

	2005	2006	2007	2008	2009*
Admissions	406	352	284	260	152
Patient days	1255	1382	1050	913	518
Occupancy	25%	27%	21%	18%	10%
Average daily census	3.4	3.8	2.9	2.5	1.8

Transient visits	416	526	502	704	898**

* 2009 data based on 293 days, not 365, due to summer and holiday closings
** Includes 178 visits for injections only

Some of the transient visitors do require partial overnight stays of up to 23 hours. Below is a table which adjusts patient days, occupancy and average daily census by including, in those figures, partial overnight observation stays. Even with this adjustment, our occupancy rate and average daily census are still very low.

Inpatient Unit — transient visits

	2009*
Overnight observation stays	163
Adjusted patient days	681
Adjusted occupancy	13%
Adjusted average daily census	2.4

Transient visits	898**

* 2009 data based on 293 days, not 365, due to summer and holiday closings
** Includes 178 visits for injections only

Even when the number of patients is very low, the Inpatient Unit must be fully staffed 24 hours a day. Often this means that some of our nursing staff is on duty with very little clinical activity. Similarly, our kitchen is fully staffed every day but is often providing meals for a very small number of patients.

Utilization of After-Hours/Urgent Care Service

Only a very small number of our total Urgent Care patients are seen between 11 p.m. and 7 a.m., and many of the visits that occur during these hours are for convenience, not clinical emergencies.

Urgent Care utilization:

	2008	2009
Total seen (all hours)	15,361	17,027
Total seen 12 a.m. - 7 a.m.	446 (2.9%)	459 (2.6%)
Where patients went after being seen:
Home	384	407
Inpatient Unit	17	16
Emergency Room	24	18
Unknown	20	18

We have seen that the winter holiday closing of the inpatient unit since 2007 and the 2009 summer closing did not interrupt our ability to care for our community. This is because local facilities or prearranged home care services were able to provide patients with the care they needed. Furthermore, events like the H1N1 influenza pandemic have also provided additional opportunities to try out the community care model and see that it works. These factors combined to support the idea of a transition to a community care model for MIT Medical.

*This news story has not been updated since the date shown. Information contained in this story may be outdated. For current information about MIT Medical’s services, please see relevant areas of the MIT Medical website.