Believe it or not, hurricanes and other disasters often cause people to reprioritize, nurture relationships with others, and—ultimately—have babies, and that is exactly what is happening right now in Louisiana. One year after Katrina hit, Baton Rouge-based Woman’s Hospital has been experiencing a spike in census, with monthly volumes up about 25% this summer.

Teri Fontenot

Fontenot explained that in April of 2005, five months before Katrina, Woman’s Hospital updated its demographic information and concluded that by 2012, the organization would outgrow its current facility. The board ultimately decided to build a new facility on a plot of land the hospital purchased in 2001 that is about 10 times larger than the current one.

But, disaster struck. “We thought we had more time to make plans for the new facility thinking that we could accommodate the volume for the next six years or so, but we have been forced to accelerate our efforts because of Katrina. Until the replacement facility is ready in late 2009, we’ll be concentrating on finding new ways to accommodate the growth in volume,” she said.

Same care, new space
Patients of Woman’s Hospital are still receiving the same high quality care the hospital has built its reputation on, many are just receiving it in an untraditional area—basically, wherever a bed is available. For instance, a mother who has just given birth might stay in a room on the GYN surgery floor or an ICU room. To compensate patients for the inconvenience, Woman’s Hospital staff present them with a gift, such as a candy-filled mug and balloon, a spa robe, or gift certificates to the several retail shops in the hospital.

Fontenot says that talking with patients early on and explaining that there is plenty of staff—just a shortage of beds—has kept patient satisfaction ratings high. In fact, last month, the hospital received the highest patient satisfaction ratings it has seen all year. “And it was one of our busiest months,” she said, adding that patients are usually not focused on their physical surroundings as long as they receive good care.

“We have to make sure every patient feels she is being treated and cared for in a compassionate way and as an individual. That is how we got our name: the 21 Ob/GYN doctors that founded our hospital chose ‘Woman’s Hospital’ because they felt strongly that every woman should feel like she is the only one here.”

Even keel
To improve throughput, Woman’s Hospital’s IS department has developed a comprehensive system and bed board report that the nursing, environmental services, and ancillary services departments use to keep track of available beds. The system is color coded so employees merely need to glance at the computer screen to learn how many rooms are available, which need to be cleaned, and which ones are occupied. Fontenot says that the directors of nursing meet once, sometimes twice, a day to assess volume versus availability.

“The system is not just used on the inpatient units. We use it in labor and delivery, the assessment center, and every other area where we might have patients who are waiting. It provides us with a great opportunity to eliminate bottle necks.”

Another tactic that has greatly improved throughput for Woman’s Hospital is placing nurse practitioners in the assessment area. The CEO explained that because the hospital specializes in the care of women and infants, it does not have the typical full-service emergency department. Instead, it has an assessment area for women arriving at the hospital in labor or with a minor emergency. Instead of having to wait for a physician, the nurse practitioner can evaluate the patient and start the care process right away.

Another small but effective means of freeing up space in the hospital is offering gift certificates to the local Wal-Mart to patients who, after receiving permission from their physicians, opt to leave earlier than their originally planned discharge time. “Even if it is only four hours, it can make a huge difference in throughput,” said Fontenot.

Nurturing nurses
Although Woman’s Hospital has been through somewhat of a whirlwind after Katrina, it applied for and received Magnet status earlier this year. Fontenot said that before the storm, the nursing staff was doing an excellent job and RN turnover was a mere 5%, so there was some debate as to whether seeking Magnet status was even necessary. “But our nursing leaders decided it would be wonderful for our staff and there were plenty of things we could learn in the process,” Fontenot said. “We already empowered our nurses and allowed them to practice pretty autonomously, and this was a way to solidify that.”

When the storm hit, the hospital considered delaying the submission of its 2,001-page application, but decided to go through with it anyway. “We said no, we are trying to make everyone understand that the high census is the new normal. We can’t let this event deter us.” The Magnet surveyors came in May, and staff learned in late July—one week before JCAHO conducted its unannounced survey—that Woman’s Hospital had been awarded Magnet status.

“Hundreds of nurses throughout the organization participated, and we did it with minimal outside assistance. We even wrote our own application because we know ourselves better than anyone else,” Fontenot said.

In applying for Magnet status, Fontenot and her team learned of a few areas that could use some improvement, one of them being appropriate nursing representation. “Magnet wants to assure that the professional practice of nursing is visible and inherent in every aspect of the organization. We saw some opportunities to reorganize our committee structures to see that nurses are better represented.”

Another opportunity for improvement is in nursing research. While several Woman’s Hospital nurses conduct research and the hospital has its own research department and PhD statistician, it was determined that better support was needed. Mostly, the CEO said, this just means making nurses aware that they have the opportunity to positively impact the delivery of healthcare. “And we can help them conduct research and publish their results in nursing journals by giving them the right tools and education. We have the resources and hope to focus nurses on opportunities to share what we’re doing in women’s health with others in the profession.”