For generations, County-USC has been seen as the hospital of last resort.
But as the crowded hospital moves into its new, smaller home, officials have a message to its most frequent users: Please, please stop coming in so much.
Because the hospital serves the poor and uninsured, some patients come back time and again -- contributing to overcrowding.
Some come in for nonemergencies, such as a homeless person seeking a hot meal; others seek help for illnesses that could have been prevented had they seen a doctor earlier. In some cases, clinics refer patients with nonemergency problems to County-USC's emergency room, thinking that they will get easier access to an important scan.
So about four years ago, COPE Health Solutions, a Los Angeles-based nonprofit, was asked to study why some patients visit the emergency room so frequently.
"What we found was that . . . there really was no road for a patient to follow to access care correctly," said Allen Miller, COPE Health Solutions' chief executive. "The system wasn't being set up to provide care on an outpatient basis."
One solution from Miller's group was to routinely refer patients, upon their release, to a clinic near their home. Another suggestion was to inform the public that anyone in Los Angeles County can find a neighborhood clinic by dialing 211.
Miller said the clinics also have access to diagnostic equipment, allowing doctors to avoid sending patients to County-USC for tests.
Another program involved identifying the hospital's most frequent users and assigning a care manager to guide them through doctors' appointments, substance abuse treatment and social services, such as trying to get housing. The nonprofit is managing about 115 of an estimated 1,300 people who frequently use the hospital.
A week after the move, County-USC's chief executive, Pete Delgado, said Friday that the transition had mostly been smooth.
Very minor issues have come up," Delgado said.
Delgado, however, said the facility is not yet operating at full capacity. Only half the operating rooms are in use as doctors and nurses train on new equipment, and technicians finish calibrating tools in the operating rooms. The surgery rooms are scheduled to return to full capacity by the middle of next week.
There have been inconveniences too. Without keys, housekeepers were unable to clean doctors' call rooms and there weren't enough porters to transport patients from the emergency room to other parts of the hospital, leaving nurses to handle the tasks. Still unanswered is whether the new facility can handle its patient load over time.
The old hospital, two miles east of downtown Los Angeles, could admit as many as 824 patients.
The new facility has a maximum capacity of 600 beds, a decline of more than 25% and one that concerns some advocates for the poor and doctors at surrounding hospitals.