Staff shortages force Luis Hospital to close surgical unit

ST. CROIX - Luis Hospital has, for now, closed its surgical unit and moved those patients into rooms on the medical floor, creating a single medical-surgical unit - resulting in an overall reduction in the number of beds available to patients.

That reduction in beds has led to longer waiting times in the emergency room for patients who are being admitted.

A mix of nurse staffing problems and regulatory compliance issues combined to make the move necessary, officials said.

"It had to do with nurse staffing," Luis Hospital chief medical officer Dr. Coleridge Franklin said of the move. "This is an issue that continues to recur with a significant shortage of staffing. It's an ongoing process. We are continuing to do what we can to increase the nursing staff."

The move also was necessary to address regulatory compliance and is aimed at improving nurse oversight and provision of care to patients, said hospital spokeswoman Xaulanda Simmonds-Emmanuel.

Combining the units into one helped maintain a proper nurse-to-patient ratio and proper oversight, officials said.

"We are having challenges with our staffing," said Luis Hospital chief nursing officer Terry Lynch. "We want to make sure that with the staffing we have, we're providing quality care, and that we match the staffing ratio."

Luis Hospital is rapidly running up against a February deadline to correct a multitude of deficiencies and meet mandates it agreed to in a settlement agreement with federal regulators at the Centers for Medicare and Medicaid Services, or CMS. The agreement is aimed at fixing problems regulators uncovered and improving patient care.

The move to combine the units involved closing the surgical unit on the second floor and moving patients to the medical unit on the third floor, Simmonds-Emmanuel said. A section of that medical unit had been closed for some time for renovations, and that recently-renovated section is where the surgical patients were moved, she said.

The move resulted in an overall loss of two medical-surgical beds, according to Simmonds-Emmanuel.

"Those beds do make a difference. It affects ER wait times," Franklin said. "That's probably the most significant impact it's had - it does affect ER wait time."

Officials say the problem is more complex than a simple reduction of two beds, though.

Of the 28 beds currently available for medical-surgical patients after the units were combined, seven are occupied by so-called "boarder" or "disposition" patients, Lynch said.

That leaves only 21 beds available for patients who need to be admitted to the medical-surgical floor.

Disposition or boarder patients are medically stable and ready for discharge, but cannot be discharged because of social issues, she said. For example, a boarder patient might be someone who is elderly and unable to care for himself, without family - or with family unwilling to take him in. These patients may wind up living in the hospital.

"A significant issue is that we continue to have long-term patients in the hospital and cannot get them out because of social issues - a plethora of issues," Franklin said. "If we can solve that problem - get these patients into placements - that would significantly improve the wait times in ER."

The issue of boarder patients has been an ongoing problem at Luis for years.

There is a lack of resources in the community - nursing home beds and other services - that might help deal with the issue, leaving the hospital strapped with the financial burden of caring for patients who no longer need hospitalization, officials said.

Addressing the issue will take a multi-pronged approach, officials said.

"It has to become a priority community issue. It's a challenge that Juan Luis is trying to accommodate as best as we can," Lynch said. "But we need some more community resources to help us. It really needs to become a community priority, a community challenge, a commitment for all the stakeholders."

Currently, with only 21 medical-surgical beds available to accommodate the island's medical-surgical inpatient needs, managing patient flow is a challenge, she said.

Waiting times in the emergency room fluctuate, depending on the number of patients who need beds and the number of patients who may be ready for discharge on the medical-surgery unit.

At one point last week, 12 people were in the emergency room waiting for beds. At another point, there were five.

"The waiting times in the ER fluctuate," Lynch said. "There may be days where it's worse, and days when it's better - when it went well."

Simmonds-Emmanuel said she did not know how long the surgical unit would remain closed.

- Contact Joy Blackburn at 714-9145 or email jblackburn@dailynews.vi.

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