A new outreach program and a focus on efficiency are helping this county hospital cope with a system overcrowded with underinsured patients.

For decades, the mammoth main facility of Los Angeles County-University of Southern California Healthcare Network (LAC-USC), has been a symbol of hope for the poor, violence-ridden communities of Eastside Los Angeles. Every day, hundreds of uninsured individuals walk through the doors of its emergency room, seeking treatment for everything from migraine headaches to severe penetrating wounds.

Pete Delgado, CEO

However, LAC-USC is taking proactive steps to address the combined issues of overcrowding and uncompensated costs. Last year, in conjunction with a private nonprofit organization, hospital administration unveiled a pilot program called Camino de Salud, designed to steer patients from the ED into private clinics. Already, it has shown promising results, said LAC-USC CEO, Pete Delgado.

In addition, LAC-USC has addressed its efficiencies in other areas through a company-wide overhaul of systems, strategies, and attitudes. But through all the change, the hospital has not lost sight of its basic mission: to serve the community, one patient at a time. “Our motivation is the impact that we have in the community,” said Delgado.

Rich history
LAC-USC has a long history of service in the Los Angeles area. It was founded in 1878 and became affiliated with the USC School of Medicine in 1885. Beginning in 1932, the hospital’s massive main building, which sits atop a hill overlooking its 72-acre campus, served as the exterior of the main hospital during the opening titles of the popular soap opera “General Hospital.”

Recording nearly 40,000 inpatient discharges, LAC-USC is one of the busiest public hospitals in the US. Its ED is the second busiest in the country, with nearly 200,000 visits annually.

In addition, it operates one of only two burn centers in Los Angeles County and one of the few Level III neonatal intensive care units in Southern California. As the largest teaching facility in the country, LAC-USC trains more than 900 residents each year and employs nearly 10,000 on its campus.

But in recent years, providing top-quality services has become increasingly difficult due to the growing numbers of uninsured. Another nationwide trend, the reduction of the number of beds, has hit LAC-USC especially hard. A decade ago, the hospital had 2,045 licensed beds to accommodate its patients. It now has about 650, Delgado said, which must be reduced to 600 by the end of this year, prior to its upcoming move into a new, 1.5 million-square-foot facility.

All of which have put strains on the organization. In 1995 and 1996, the medical center was part of proposed budget cuts to reduce the county health system’s deficit then at $655 million, but LAC-USC survived.

Forward thinking
Looking ahead, the hospital is focusing on how programs such as Camino de Salud will help solve the debilitating issues of overcrowding and uncompensated care, Delgado said. With a $750,000 grant funded by Unihealth, LAC-USC established a three-year partnership with COPE (Community Outreach for Prevention and Education) to implement Camino de Salud. The three-year project began with approximately 60 patients, expanded to 130, and is currently ready to launch to 1,000 patients, depending on funding.

The program has worked, Delgado said, because it’s a holistic effort designed to provide “frequent fliers” (chronic users of the ED whose care would be far less expensive if they were seen regularly by primary-care physicians) with the information and education they need to take control of their health. The program focuses on a comprehensive approach to treatment instead of the temporary fix provided in the ED, while demonstrating to patients the advantages of routine primary-care treatment.

Camino de Salud is based on partnerships with nine community clinics in the area, which are assigned based on the proximity to the patient. Patients are assigned a health coach who helps them understand how to take control of their conditions, as well as providing logistical support, such as help with public transportation, for the many patients who are illiterate. The program also demands patients to take ownership of their health problems, instead of relying on the ED for last-minute care.

“This is what health reform should be,” Delgado said. “It’s a way to coordinate the fragmented healthcare system that we’re in. The ultimate goal is to get the patients a better experience, better outcomes, and improve their quality of life. But from the business side, the goal is to manage the 5% to 10% of the patient population that drives 40% to 50% of total healthcare costs.”

Improving operations
Along with managing ED traffic, Delgado has taken a hard look at patients’ average length of stay. The hospital’s upcoming move will be into a smaller building, which means it needs to provide service in a timelier manner to accommodate a comparable number of patients.

When Delgado came aboard in 2003, the hospital’s average length of stay was 6.7 days, a figure that needed to drop to 5.5 days to align with the move, he said. He and his executive team implemented 10 new programs and a half-dozen redesigns of ancillary and clinical processes, all focused on improving efficiencies, reducing costs, and streamlining resources.

For example, it used to take three days from the time a doctor ordered a CAT scan until a technician scheduled it. Since the redesign, it takes 12 hours or less, Delgado said.

“We have the same technicians and the same machines, but we monitor them every day now,” he said. “We get a report every morning, so we know when a scanner is down or a technician is not here, and we can get registry help as quickly as possible. Before, if an employee was out, it meant productivity was down.”

Such efforts have paid off. In February, the average length of stay was 5.1 days, well under its goal. That achievement is just one example of the recent successes that LAC-USC has experienced across the board, Delgado said.

“We’ve got a nice momentum going here,” he said. “The physicians and staff are aligned, and people are getting excited that what we said we’re going to do we’re actually accomplishing.”

Blane Bachelor is an Atlanta-based freelance writer who covers travel and business. She can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it