No More “Code Black” in LAC+USC

By Abner Galino

Image © https://universitiesicaliforniabrati.blogspot.com

THE efforts undertaken at the Los Angeles County+University of Southern California Medical Center markedly reduced patient wait-times and overcrowding, and improve patient flow throughout the hospital – reducing time spent in “Code Black,” the most critical level of hospital overcrowding.

This was revealed in a study published in the April issue of the American Journal of Medicine.

The LAC-USC Medical Center is so busy that a former resident physician of its Emergency Department created the “Code Black” documentary and television series, a close up look at the inner workings of the hospital.

The hospital is the largest public medical facility west of the Mississippi and has one of the busiest Emergency Departments in the U.S. The number of patients cared for is so large that the hospital has long struggled with overcrowding.

In the new scientific manuscript, physician and nurse leaders at LAC+USC describe efforts to work with front-line staff to implement a series of no-cost, efficiency interventions to improve patient flow.

Hospital staff developed and enforced strict criteria for telemetry, step down and intensive care units to move inpatients more efficiently through the continuum of care, freeing beds for hospital-admitted patients in the Emergency Department.

The result was a remarkable improvement in dangerous and critical overcrowding in the hospital.

“Like other safety net hospitals in high density urban areas, LAC+USC has historically been ground zero for emergency services demand,” said Los Angeles County Supervisor Hilda L. Solis.

“At LAC+USC, providers and staff are working in partnership to comprehensively support the needs of the community and advance towards a future of shared prosperity and health for all. I want to commend the LAC+USC clinical and administrative staff for their efforts to innovate and to overcome these operational challenges, and for continuing to deliver excellent care to our most vulnerable and often underserved patients from across the County.”

At baseline, the hospital spent an alarming 55% of time in dangerous (Code Red) or critical (Code Black) overcrowding conditions; after the interventions, the hospital spent <5% of its time in such conditions.

The improvement in patient flow is a result of teamwork across many professional disciplines,” said lead author and LAC+USC director of inpatient services Charles Coffey Jr., MD, MS.

As a result, patients are able to get the high-value hospital care they need and deserve in a much more timely manner.”

Senior author and LAC+USC chief medical officer Brad Spellberg, MD, said the efforts should improve patient satisfaction and reduce staff burnout.

It’s noteworthy that the hospital achieved these goals with existing staff and without having to purchase new technology, and by improving our processes. The television series brought attention to the challenges that LAC+USC faced, but I guess they will have to change the name of the show!”

Many said it could not be done in one of the busiest Emergency Departments in the country,” added LAC+USC chief executive Jorge Orozco, “but this effort reflects our staff’s deep commitment to providing world-class care to our community.”

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