Legacy Salmon Creek Medical Center is eliminating many of its inpatient pediatric services to make room for the growing number of adult patients.
The restructuring, which goes into effect Wednesday, will send some pediatric patients needing inpatient care to other hospitals — either Randall Children’s Hospital at Legacy Emanuel in Portland or, in some cases, PeaceHealth Southwest Medical Center — and make room for more adult patients who need to be admitted to the hospital, said Denise Fall, Legacy Salmon Creek’s nurse executive.
“We have adult patients that really need inpatient beds,” she said. “We believe it’s the right thing to do.”
In 2014, Legacy Salmon Creek had 15,156 inpatients; of those, 371 were in the pediatric inpatient unit. Those pediatric inpatients accounted for 2.4 percent of all hospital inpatients.
The pediatric inpatient unit has eight beds and, in 2014, had a daily average of two patients. The unit numbers typically peaked during cold and flu season and dropped during other times of the year, Fall said.
Legacy Salmon Creek will continue to provide services for two subsets of the pediatric inpatient population: infants younger than 29 days and teens older than 15 who need surgery or orthopedic care, Fall said. In 2014, 49 percent of pediatric inpatients (about 182 children) would have fallen into one of those population subsets.
The infants will receive care from pediatric physicians and nurses working in the neonatal intensive care unit and pediatric emergency department. The teens who need to be admitted for surgery or ortho care — an appendix or gallbladder removal or a fracture, for example — will receive care, at the surgeon’s discretion, in the adult surgical specialty unit, Fall said.
The pediatric patients who don’t fall under either of those subsets but need to be admitted to a hospital — such as those with upper respiratory issues or dehydration from illness — will be transferred to Randall Children’s Hospital. Low acuity patients may also be transferred to the pediatric inpatient unit at PeaceHealth Southwest Medical Center, Fall said.
PeaceHealth Southwest has an eight-bed pediatric inpatient unit in its Family Birth Center. The unit is staffed by pediatric nurses who are cross-trained and work in other units when the pediatric unit patient numbers are low, said Melanie Fain, nurse manager for the PeaceHealth Southwest NICU and pediatric units.
The PeaceHealth Southwest pediatric inpatient unit has a daily average (or census) of two patients, leaving the unit with room to care for more pediatric patients and keep families in Southwest Washington, Fain said.
“We’re excited at the prospect of having a higher census in our pediatrics department,” she said.
Legacy pediatric patients with higher-complexity needs will be transferred to Randall Children’s Hospital, just as they have in the past.
Legacy Salmon Creek Medical Center will continue to operate its pediatric emergency department and pediatric outpatient clinics, and the staff who worked in the pediatric inpatient unit are all cross-trained and will work in other areas of the hospital, Fall said.
The changes to the inpatient pediatric unit are the result of the surging number of adult patients in the emergency department and women’s services in the last 1 1/2 years, said Bryce Helgerson, chief administrative officer at Legacy Salmon Creek. The number of adult patients started to climb after a new agreement between Legacy Salmon Creek and Kaiser Permanente for local hospital services went into effect Oct. 1, 2013.
“What that’s really done is put a pinch on inpatient beds,” Helgerson said.
The result, Helgerson said, is longer emergency department waiting times and more people leaving without being seen because inpatient beds are taking longer to open up.
“Frankly, that’s something we don’t want to continue here at Salmon Creek,” he said.
The increase in women’s services, such as labor and delivery and postpartum care, has also led to women with new babies overflowing into the adult inpatient unit and being moved multiple times after delivery, Helgerson said.
The women’s services unit will, beginning Wednesday, overflow into the vacated pediatric unit, rather than taking up those adult inpatient beds, Helgerson said.
“In order to improve patient flow, we’ve made the difficult decision to make changes to the patients we admit to the hospital,” he said.
