Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Like all large academic medical centers (AMCs), we face capacity challenges. On most days, bed occupancy is often greater than 90% and long boarding times in the Emergency Department (ED) leads to poor patient experience, care delays and risk for adverse outcomes. While many AMCs have approached this problem by acquiring new facilities or [...]

Background: Specialty wards (e.g., cardiology or oncology wards) group clinically similar hospitalized patients in efforts to improve outcomes and costs. When these wards exceed capacity, subsequent patients overflow to “geographically dispersed” alternate wards. Geographic dispersion has been associated with care inefficiency and worse outcomes on specialty wards, but has not been studied in a large, [...]

Background: Hospital disaster response has historically been the purview of emergency medicine and surgery, without significant involvement of hospitalists themselves or consideration of how mass casualty incidents impact the hospital as a whole. However, many disaster modalities, e.g. pandemic infectious disease or bioterrorism, are outside of the surgical scope of practice and require involvement of [...]

Background: Partnership with Regional Medical Centers is a growth strategy for Virginia Mason as well as a service to our patients in the community. It is important to maintain our capacity to provide care to all patients wanting to come to Virginia Mason. Deflections, when we turn away patients from outside transferring hospitals, are expensive [...]

Case Presentation: The patient is a 74 year old woman with past history of dementia and an aggressive right upper lobe cavitary mass who presented with post-obstructive pneumonia. The lung mass was diagnosed two years prior, however, the patient refused further workup. The patient named her two daughters to be dual healthcare powers of attorney [...]