What follows are excerpts of comments sent by e-mail to the Times by Carolyn Clark, a spokeswoman for the James A. Haley VA Medical Center in Tampa. The term "diversion" refers to the hospital's practice of turning away patients because it is too full or too busy:
We have significantly reduced the amount of time our Emergency Department is placed on diversion status this year. For example, diversion hours went from 518.26 hours in the first quarter of FY07 to 133.25 hours during the same time period in FY08 — a 74 percent reduction. The reduction in diversion hours for the second quarter of FY08 is even better. We were on divert status for 1,024.25 hours in the second quarter of FY07 compared to just 189 diversion hours in Quarter 2 of FY08 — an 82% reduction.
Looking at FY08 thus far, as of July 31, we were on diversion a total of 554.55 hours. For the same period in FY07, our total diversion hours were 1,797.25. This means that 10 months into FY08, we have reduced our total diversion hours by nearly 70 percent. Our end of year figures are expected to be even higher.
We made these significant gains by increasing capacity — adding an additional 31 inpatient beds — and by maximizing our efficiency, evidenced by our length of patient stay, which is consistently below Center for Medicare (CMS) standards. In fact, we have one of the lowest lengths of stay among all hospitals in the VA's VISN 8 Network.
Although we have made remarkable improvements in our diversion rates, we will continue to streamline our processes and maximize the efficient throughput of patient flow — without compromising patient care. We will also continue to evaluate the need to add additional inpatient beds....
The VA treats all patients in emergency situations, in full compliance with the Federal Emergency Medical Treatment Active Labor Act (ETALA) and COBRA. However, if VA does not have the capacity or capability to provide required care in one of its facilities, healthcare is arranged for eligible veterans using community resources. In the case of veterans without a military service-connected disability, Medicare is the primary insurance payee with a co-pay required of the veteran. In the case of eligible veterans with military service-connected disabilities, the health care is cost-free with VA paying 100 percent of the bill. VA complies fully with all federal regulations and U.S. Codes as it pertains to health benefits...
Tampa remains one of the busiest VA hospitals in the nation, with nearly one million outpatient visits and over 13,000 inpatient admissions in 2007.
To give you some perspective, in 2000, we had about 48,000 unique patients (individual patients who came at least once to the hospital. Most patients see their providers about 10 times over the course of the year.) By the end of FY2007, 116,031 unique patients had received care and through July 2008 of this fiscal year, we have provided care to 107,144 unique patients.
Over the last two years, Tampa's patient growth appears to have stabilized, however, the current population continues to age, requiring more emergency room visits and inpatient stays.
Space on the main hospital campus is a definite issue. We're working hard to free up additional bed space by expanding on-site, by reallocating space within the hospital, and by moving outpatient functions off-site.
Here is a snapshot of our initiatives to expand and improve:
We're moving five Primary Care teams, the Outpatient Pharmacy, the Dermatology Clinic and the Eye Clinic out of the main hospital to leased buildings close to the hospital. Most of these moves are expected to be completed by Spring 2009.
We're also expanding on and off campus. In June 2008, we opened a new 30-bed ward in our world-class Spinal Cord Injury Center, bringing the total number of beds in the SCI "hospital within a hospital" to 100. Also, new on-site modular buildings provide about 33,000 additional square feet of space for the Polytrauma program and other functions.
We're adding a 50-bed mental health inpatient ward, a 9,000 sq ft expansion. That project is expected to be completed by December 2008. We've also added 22,000 square feet of space to our Operating Room and Laboratory areas.
A major project that has been approved is construction of a nearly 100,000 square foot, state-of-the-art Polytrauma Healthcare Center that will consist of two new floors of the hospital plus a mechanical penthouse for infrastructure support. Part of this project includes a much-needed 1,500 space parking garage. This project will be underway in 2009.
To provide care for our patients close to where they live, several VA Outpatient Clinic expansions and new facilities are in the works. All facilities are in leased buildings.
Completed in June 2008, the Zephyrhills Community Based Outpatient Clinic (CBOC) opened a new 2,155 square foot expansion of its mental health services. The new building is located across from the existing clinic.
The Lakeland CBOC has outgrown its current 4,140 sq foot facility and will relocate into a larger, 10,000 sq ft building and a second new building of the same size housing a Satellite Mental Health Center . The new mental health center will be located behind the new CBOC on 4231 South Pipkin Road . The main CBOC is expected to be completed in the fall of 2008; the mental health center is expected to be completed in early 2009.
Meanwhile, a 4,000 sq ft expansion to the New Port Richey Outpatient Clinic (OPC) is expected to be completed in mid-2009 and a new 5,271 sq ft Satellite Mental Health Clinic will be built about 2 and a half miles from the current VA clinic on Little Road. Also, construction of a new 3,200 sq foot dental clinic in New Port Richey began in July 2008; it's expected to be completed in the fall of 2008.
With the population exploding on the South Shore, a new 50,000 sq ft Outpatient Clinic is also being planned in South Hillsborough County . The clinic has been approved and design, build and activation is planned for the 2010 timeframe. With a planned staff of more than 150, clinic services will include primary care, outpatient mental health, specialty care including audiology, podiatry, urology, women's health care, cardiology, endocrinology, neurology, orthopedics, outpatient surgery, radiology, pharmacy and laboratory.
With these ongoing initiatives and a highly motivated staff dedicated to providing veterans with the very best healthcare available, we are confident that improvements will continue to be made ensuring our patients have access to care when and where they need us most.