Feedback: Long patient waits at UK sign of success

August 31, 2014 

Dr. Michael Karpf is confident the request for more beds will be approved.

  • At issue: Aug. 24 Herald-Leader article, "UK's 'Ferrari' of ER struggles with wait times door-to-bed clocking slowest in state at 10 hours, 44 minutes"

The Herald-Leader recently pointed out that I had described our new emergency room as a Ferrari, but that it was slow with long stays for patients.

I stand by the analogy — our emergency room is one of the most sophisticated and technologically advanced ERs in the country. I also recognize patients have had long stays before being admitted. Why this apparent contradiction?

The answer is simple; dramatic demand for our services has outstripped our present physical plant — too much weight on the chassis. Our success, in other words, is fueling greater challenges. But we are quickly working to grow to meet demand, and in the process, extending access to advanced, specialty care farther across Kentucky.

That's our mission.

About 10 years ago, we committed to mature UK HealthCare into a research intensive, referral academic medical center to ensure "all Kentuckians — no matter how complex their medical problem — could be taken care of in Kentucky and not worry about whether their insurance will let them to go out of state."

The consequence of this strategy has been substantial growth beyond our initial aggressive projections.

In fiscal year 2003, Chandler Hospital had 19,098 discharges. In fiscal year 2014, which ended June 30, we had 35,180 discharges and anticipate between 36,000 and 37,000 discharges for fiscal year 2015.

Based on our anticipated volumes for 2015, we will have grown more than 90 percent in patient volume — that's right, we have nearly doubled. Our surgery volumes have also increased 81 percent. At the same time, the severity of illness of our patients, as measured by Medicare indices, has also increased. Currently, we have one of the most complex patient populations of any academic medical center in the country.

With our growth we have gone from a small academic medical center in the 25th percentile of academic medical centers, to a large academic medical center now close to the 75th percentile.

Yet, during this growth spurt, we have improved in efficiency, quality, patient safety and patient satisfaction as documented by UK HealthCare earning the "Rising Star Award" from the University Health System Consortium. UHC analyzes data from 118 academic medical centers to benchmark against and learn from each other.

The Rising Star Award recognized our move from 52nd to 12th in composite score in efficiency, quality, safety and patient satisfaction — the highest jump the UHC had ever seen. Given our size and complexity, the true comparison group for us are the other academic medical centers that are UHC members.

But with more volume and complexity, how do we solve our ER delay problem? Simple: Expand capacity to match demand. That is, we need to bulk up the chassis and engine to carry the additional weight.

First, on Dec. 7, we will open a new 64-bed cardiac floor in Pavilion A and shortly thereafter, a 22-bed observation unit adjacent to the emergency room. The cardiac floor will also be one of the best in the country.

Second, we received approval from the commonwealth to sell (and repay), an additional $150 million in bonds for a project which we will announce in detail in the next several months. This will make our overall billion-dollar expansion 80 percent complete.

Third, we have submitted a letter of intent to the state for an additional license for 120 beds. Today, we are licensed for 825 beds. Using a benchmark length of stay, which we have already achieved as well as an 80 percent occupancy — the industry standard for efficiency — we will need a total bed capacity of approximately 945 beds to meet future needs.

The consequence of our growth is more and more Kentuckians now want to remain in Kentucky for complex sub-specialty care and destination services. All of this means we are fulfilling the promise we made 10 years ago.

We are also seeing an increased number of patients from West Virginia, Ohio and Tennessee because of the quality and attractiveness of our destination services.

The economic impact for the commonwealth has been substantial. UK HealthCare (the hospitals, College of Medicine, faculty practices and affiliated entities) has doubled the number of full-time equivalent employees from 5,438 in fiscal year 2004 to 10,831 in fiscal year 2014. The personnel costs (salary and benefits) have increased from $375 million in fiscal year 2004 to $903 million in fiscal year 2014.

Our growth is good for health care. It's also good for the economy. Because of our excellence in clinical care and research, we will also keep Kentucky's best students and attract excellent students from outside Kentucky to train for health care professions that will help build the medical work force for the commonwealth of the future.

Dr. Michael Karpf is executive vice president for health affairs at the University of Kentucky.

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