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Cramped Haley Looks To Nearly Double Space

JIM REED / The Tampa Tribune

James A. Haley VA Medical Center is combating its space shortage by moving administrative offices to create bed space, chief of staff Edward Cutolo says.

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By JOHN W. ALLMAN, The Tampa Tribune

Published: December 5, 2007

Related: Haley Complaint Points To Psychology Trainees

TAMPA - The nation's busiest VA hospital doesn't lack resources or staff.

What the James A. Haley VA Medical Center lacks is space, officials say - space for parking, space for more treatment area and space for more beds.

The number of available beds, in particular, both in Haley's Intensive Care Unit and for patients who require monitoring or specialized care, has contributed to higher-than-preferred diversion rates, according to Edward Cutolo, chief of staff.

This year, Haley has diverted patients 27 percent of the time to other hospitals because of a shortage of ICU bed space, Cutolo said, and 16 percent of the time because of the hospital being at capacity. Haley has 39 ICU beds.

The hospital needs to nearly double its size, Cutolo said, citing a report by the federal Department of Veterans Affairs. The analysis said the 49-acre Tampa campus, which includes more than 1 million square feet of space, needs to grow by about 960,000 square feet.

"At this point, it's just a matter of the time it takes to get things done," hospital director Stephen Lucas said.

Some changes that are in progress:

•By spring or fall 2008, Haley will move its primary care patients to an off-site location to free up room for treatment. About 4,000 people a day visit the hospital for primary care needs.

•The hospital added 31 beds in 2007 and hired 35 more registered nurses. Cutolo said he would like to add at least 30 more beds to help reduce the diversion rate.

•The hospital recently added free valet parking and plans to move staff parking, freeing up about 900 additional on-site parking spaces. Officials also negotiated a contract for 1,000 additional parking spaces at nearby University Mall, which can be used by staff or visitors.

•Haley's outpatient pharmacy will be moved off-site, freeing up more parking. The pharmacy, according to Cutolo, fills more prescriptions per day than 100 CVS pharmacies combined.

Haley Gets Active-Duty Referrals

Space hasn't always been a problem. Haley opened in 1972 with 700 beds, but by 1995, that total had dropped to 358 because more patients were being treated and released, reducing the need for so many beds. The space was absorbed by other needs, such as administrative office space.

But Haley is much busier now - and it is reclaiming that space for patients. For example, many administrative offices have been moved outside into portable trailers.

Haley is one of four VA hospitals where war-time, active-duty military soldiers are referred. It receives patients for specialty care from other VA hospitals, notably Orlando, St. Petersburg and Washington. And it has seen an upswing in annual admission rates by about 2,000 patients since 2005.

"It's kind of an efficiency issue, and space is a major constraint," Cutolo said, "and we're working on that."

One area where the constraint is felt is diversion, the practice of rerouting ambulance patients to nearby facilities.

Diverted patients are not patients with scheduled medical procedures or those admitted after arriving for primary or emergency care. Haley pays the medical costs - $3.7 million this year - for any veteran diverted to another hospital.

That doesn't mean the hospital's emergency room couldn't handle additional patients. It means that there was no room in ICU if an emergency room patient needed to be admitted.

In June, the hospital opened a new emergency room with 14 beds, an increase of six beds. Cutolo said officials plan to reopen the old emergency room soon to provide 10 more beds, giving the hospital 24 emergency care beds total.

'Stacking' Patients Not An Option

Cutolo said that officials willingly diverted people to avoid having to "stack" them, a term that refers to patients left waiting on a gurney in a hallway or other part of the hospital until a room becomes available.

"We really think it's the right thing to do for patient care and safety," he said.

The practice of diverting patients isn't isolated to Haley. Officials at Bay Pines VA Medical Center in Pinellas County have worked for two years to significantly reduce its diversion rate from 21 percent in 2005 to 5.7 percent this year.

Bay Pines also has seen a spike in patient treatment, admitting nearly double the number of patients, 95,000, this year than in 2000.

Bay Pines chief of staff Jeff Van Buskirk and other officials attended national training about patient diversion, spokeswoman Faith Belcher said. The hospital adjusted its staffing to meet peak time periods, streamlined its admission process and expanded its emergency room. By spring 2008, Bay Pines will have 20 emergency room beds, an increase of 12 beds since October 2003.

Haley is taking a similar approach to improving patient flow and reducing its diversion rates.

"It's extremely complicated. By going on diversion, we're able to have the option of providing safer care," Cutolo said.

"Ideally, we want to provide all the care here, not only for cost, but continuity and quality."

Reporter John W. Allman can be reached at jallman@tampatrib.com or (813) 259-7915.

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