Wellstar Atlanta Medical Center shuttered Nov. 1. In the month that followed, Grady Memorial Hospital — now the only level 1 trauma center in the city — assumed a portion of AMC's patient load and made adjustments to its staff and facilities to accommodate the rising volume.
Becker's recently connected with Robert Jansen, MD, chief medical officer and chief of staff at Grady, to learn how the hospital is holding up.
'Significant' increase in trauma volume
The biggest effect Atlanta Medical Center's closure had on Grady Memorial Hospital was a "significant" increase in trauma volume, Dr. Jansen said. Grady was already the area's largest trauma center, and when AMC's patients began to funnel into its emergency department, the trauma volume increased 25 percent to 30 percent, according to Dr. Jansen.
Air traffic has "probably doubled" since AMC's closure, Dr. Jansen said, with patients arriving by air ambulance almost hourly. Grady also assumes all high acuity trauma patients.
"We remain completely full. We were already running close to capacity or at capacity prior to AMC closing. We're now at capacity daily," he said.
An increase in trauma patients was expected because AMC's trauma volume was about 50 percent of Grady's, Dr. Jansen said. But the Georgia Coordinating Center, which helps route emergency medical services to the hospital with the highest capacity at a given time, has helped dilute the number of patients coming to Grady, resulting in less volume than anticipated.
"[The Georgia Coordinating Center] has done a good job during this time making sure EMS traffic is distributed across the city a little more evenly so all the AMC traffic did not come here. That would have overwhelmed our ED," Dr. Jansen said.
Uptick in OB volume
Grady has been seeing more obstetrics patients since AMC shut down — a less-anticipated consequence of the closure. AMC had a fairly large obstetrics service, Dr. Jansen said, and Emory Midtown Hospital has also seen a rise in deliveries.
Grady has seen about a 40 percent increase in deliveries in the last month.
"One of the shames of this, one of the tragedies, is a lot of these patients did not have adequate prenatal care," Dr. Jansen said. "The downstream effect of that is that our NICU volumes have also increased significantly to the point where we're running out of capacity."
Changes to staff, facilities and triage
Grady has implemented changes to keep up with the increased patient volume.
The hospital is recruiting additional staff, including former AMC employees.
"We did hold job fairs for AMC employees and we were actually able to hire a number of those employees. We hired three trauma surgeons that were previously working at AMC that will be starting here in December," Dr. Jansen said. "We sometimes forget about the displacement those workers felt. Giving them an opportunity here has been good for them and good for us."
The hospital has added beds, including a 29-bed unit adjacent to the emergency department that has been a "lifesaver," Dr. Jansen said. There was discussion of a mobile unit coming from the state, but it has not arrived. Dr. Jansen said he is unsure when it will, though the hospital had hoped it would be there by December.
Grady has also added on-demand telehealth visits and a 911 triage system to decrease the number of patients that pass through the emergency department without actually needing to be there. These programs have been successful, according to Dr. Jansen, although he does not have exact numbers of how many patients have utilized the services.
"A patient had actually come to the emergency room with a minor illness and was told that this was available, they could have a televisit instead of waiting in the waiting room," he said. "They left the emergency department and went home and called and did that televisit. So it is having an impact."
In addition, Grady has a transitional care clinic next door to the emergency department — essentially an urgent care center, Dr. Jansen said — that people can be referred to if they have a lower acuity case. The hospital is working on increasing the clinic's walk-in staffing and lengthening its hours.
Among Grady's staff, there was a lot of anxiety surrounding AMC's closure, but "now that it has happened, they realize, yeah, it's happening, but it's manageable," Dr. Jansen said.
"We are a resilient organization."
A 'cautiously optimistic' outlook
Winter is a "dangerous time from an emergency medicine perspective," Dr. Jansen said. December and January are the worst months for respiratory illnesses driven by influenza and COVID-19, so he said he believes the emergency department will "get worse."
Additionally, social unrest has contributed to more gunshot and stab wounds. These violent injuries have increased about 60 percent year over year, which adds to the emergency department's volume, Dr. Jansen said.
However, he said he remains "cautiously optimistic" about the year ahead.
"I'm optimistic that 2023 is actually going to be a good year for us," Dr. Jansen said. "It's going to be a little bumpy to start. I hate to say it, healthcare is bumpy right now. Grady in particular has endured a lot."
But the hospital plans to open another 180 beds, as well as a state-of-the-art ambulatory surgery site in the coming year.
"Yes, we are working at capacity. Yes, Emory Midtown is working at capacity. But we are going to take care of patients when they come here." Dr. Jansen said. "All hospitals in the area have rallied to this."