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Shortage of Beds Is Straining Hospitals

Health: Many facilities in the state delay care and shuffle patients. The problem may get worse.


After years of empty beds and hospital closures, a growing number of medical centers in California are straining from surging demand and not enough beds to provide sufficient care.

The shortage of hospital beds has caused delays in elective surgery and other admissions, more diversions of patients to other facilities and problems that have added to the backlog in emergency rooms.

Hospitals are responding by installing sophisticated bed-tracking systems, adjusting surgery hours and developing ways to do more procedures on an outpatient basis. Some have converted offices into patient rooms, adding a smattering of beds.

But there are few new hospitals being built in the state. And with a critical shortage of nurses and more hospitals almost certain to be shuttered, many health providers and analysts said the capacity crunch being felt by some will spread and get progressively worse.

Most of the effects so far have been matters of inconvenience rather than life and death, but if the trend continues, experts say it could have an effect on care.

Ian H. Taras, an obstetrician and gynecologist in the San Fernando Valley, said he is scheduling caesarean sections into November because the medical center he uses in Tarzana usually is full.

The most difficult cases, he said, are patients whose needs are between serious and urgent. Earlier this year, when an expectant mother of twins went into pre-term labor, he told her to check into Encino Tarzana Regional Medical Center. But the Tarzana hospital was packed, and Taras and his patient hastily changed plans and went to West Hills Hospital a few miles away

"She was counting on going to Tarzana," he said.

Orthopedic surgeon Kent Adamson said he is working more successive late-night shifts, waiting for an open operating room at Mission Hospital Regional Medical Center in south Orange County. That's made his job more stressful.

"It's doable but not the optimal situation," he said. "I feel we're treading and treading pretty hard and succeeding, but how long can you stay afloat?"

Dozens of hospitals, especially smaller ones, still have plenty of unused beds. But statewide, the occupancy rate of available hospital beds--which had remained at the same level during much of the last decade--has risen steadily since 1996 to 64% last year, according to the Office of Statewide Health Planning and Development. Many hospitals are running well above that average, and some are exceeding the 85% rate that experts consider essentially full.

In the last two decades, more than 100 community hospitals have closed in California, according to a July 2001 study by Shattuck Hammond Partners, a consulting firm. The state Department of Health Services said there are about 450 acute-care hospitals in the state.

Many hospitals have collapsed under financial pressure from managed care, cutbacks in Medicare and government reimbursements and what many considered too much competition.

Although hospitals nationwide are running out of beds, in many ways the problem is more critical in California, which has far fewer hospital beds per population than most other states. Yet California's population is growing much more quickly than the nation as a whole, and for the first time in many years hospital usage and average length of stays are increasing.

The rise in hospital visits and stays is expected to continue, reflecting the loosening of restrictions under managed care, the aging of baby boomers and a higher percentage of critical cases, which some believe is partly the result of delayed care.

Childrens Hospital Los Angeles said it is facing an unprecedented increase in demand for services.

Occupancy at the 314-bed hospital is hovering at close to 80%. The hospital acknowledged that lack of staff and resources has contributed to delays in treatment.

"But these delays are generally hours, not days," the hospital said, noting that it has not reached a point in which care has been compromised.

At Cedars-Sinai Medical Center, 95% of its 850 available beds were occupied on a recent Friday. The hospital had no flexibility because the few vacant beds were for only pediatric and obstetrics use.

Linda Burnes Bolton, the hospital's chief nursing officer, said there was a bed for each of the 75 surgeries scheduled for that day. But by early afternoon, five doctors who wanted to admit new patients were told to wait.

"This is a typical Friday," said Bolton, who meets three times daily with other managers to map out the day's bedding situation.

Until February, when Cedars-Sinai added surgery on Saturdays and had them go later into the evening on weekdays, the Los Angeles hospital was forced to cancel three or four surgeries a day. Since then, the hospital has not canceled any scheduled operations, Bolton said.

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