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Hospital merges medical, surgical departments

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In the name of efficiency, and ultimately managing costs, Douglas County Hospital (DCH) will merge its medical and surgical departments on June 17.

"Throughout the organization, we believe the merger will help us meet our responsibility to our community as a healthcare provider and one of the area's economic drivers," said Carl Vaagenes, CEO of the hospital.

The push to merge medical and surgical floors stems from declining census, or fewer people admitted to the hospital.

Margaret Kalina, DCH's director of patient services and chief nursing officer, said, "Since 2007, like most hospitals, we've seen a slight decrease in our inpatient census. We thought maybe that would not happen, but it has because health care reform and initiatives out there are really driving less hospitalization and more outpatient [services].

"Medical and surgical at our hospital have been separate for years and probably because there had been the volume to support two distinct floors. However, when we started asking other hospitals, bigger, smaller and of similar size, because of fluctuating census everybody has seen, they have merged [medical and surgical] too," Kalina said.

Hospitals in Willmar, Fergus Falls and Bemidji are similar in size to DCH and all have merged their medical and surgical departments.

"It's not necessarily that our market share is declining, it's the medical interventions and way in which care is provided that is changing," Vaagenes said.

For example, heart failure patients arriving at DCH emergency room are eventually sent to St. Cloud Hospital and not admitted to DCH, contributing to declining census.


Vaagenes and Kalina said they didn't have a figure on how much money DCH will save by merging the medical and surgical departments.

"I'm not sure what the dollars would be; it really depends on what the census is," Kalina said.

In the long run financially, Vaagenes said, "We're expecting, like most hospitals and health systems, to reduce costs by 15 to 20 percent under the Affordable Care Act. In addition, more pressing immediately, is the federal sequester and that started to hit us effective April 1, where there was a 2 percent cut across the board in the federal budget to Medicare spending. That for us has been a $1 million cut in reimbursement to our facility on an annual basis."

Vaagenes said DCH is looking at efficiencies across the organization and merging medical and surgical is just one area of many in the facility that it's exploring.


Efforts have been in the works for a while to train and prepare nursing staff for the change.

Approximately half of the hospital's nursing staff are already cross-trained to work in both medical and surgical departments.

"We see this as an opportunity for staff to have skills in multiple areas," Kalina said. "I think they're doing very well."

The merger eliminates the need for scheduling a charge nurse and medical secretary for the separate departments. Now, there will be one charge nurse and one secretary on duty for the combined department.

During the May 31 DCH board meeting, Kalina told the board, "We've already held five postings that we're not replacing... and by fall I know a few more retirements are coming through, so I don't anticipate any layoffs with this [merger]. This is how I see we'll preserve jobs, by being efficient."

DCH's census can fluctuate from about 25 to 85 patients per day.

"So if you can imagine, in any organization, trying to staff with that great a variation in your census, it can be challenging at times," Vaagenes said.

Vaagenes added, "I think this is also helpful for us, as our staff receives additional skill training and so forth, it not only gives us more flexibility in staffing to those variations in census, but it also provides better job security for staff with the additional skills. With those skills they can work in a couple areas [of the hospital]."

During last month's meeting, hospital board member Kevin Kopischke said, "It seems any type of change... it's particularly troubling for organizations, but it's inevitable that we deal with efficiency. So, let's get together and make sure we're dealing with reality and ask questions, like, can we be working a different way?"


Both medical and surgical departments are already located on the second floor of DCH; medical in the older tower of the hospital and surgical in the new addition.

Now, as of June 17, the newly combined "med-surg" floor will be treated as one. The majority of patients will be located in the new addition with overflow cared for on the newly remodeled area in the older section of the hospital.

Renovation of the older tower rooms was recently completed and Kalina said it's an opportune time to proceed with the merger.

There are 52 beds on the newly merged floor, and all are single patient rooms.

The merger should be seamless for patients, according to Kalina.

Amy Chaffins

Amy Chaffins is a journalist working for the Echo Press newspaper in Alexandria, Minnesota.

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