CHC struggles with rising population

The Commonwealth Health Center, the only hospital in the CNMI, opened to the public in 1986. At the time, it was built to serve a population of less than 20,000.

Today, 31 years later and with a CNMI population that is conservatively estimated at 50,000, the hospital is struggling to keep up.

The more than doubling of the population and the current state of the hospital’s size means that CHC is constantly experiencing a shortage of rooms, faced as it is with high volumes of patients that are being admitted to the hospital.

The situation has reached a point where the Commonwealth Healthcare Corp., which runs the hospital, has expressed concerns regarding the hospital’s capability to provide proper healthcare.

“The hospital has been receiving a high census. The census is huge; our physicians stay late nights and our nurses are exhausted because of the fact that it is a closed acute care facility. This requires more attention from our nurses,” said CHCC chief executive officer Esther Muña.

“What we’ve seen lately is [CHC’s full capacity] every day.”

Under these conditions, the quality of healthcare is affected, Muña concedes.

Nurses and physicians that are sleep-deprived have a harder time focusing on the patients and they are risking their own health, largely because of the possibility of developing medical conditions that arise from sleep deprivation, such as higher risk to chronic health problems: blood pressure, heart disease, and stroke, to name a few.

“If you have an issue with staffing, that means they have to work overtime, which is concerning to [CHC] financially and also affects the quality of care,” Muña said.

CHC hospital administrator Jesse Tudela told Saipan Tribune that the wards most affected by the high census are the medical and surgical units and the intensive care unit, or MedSurg and ICU respectively.

“The ICU consists of only four rooms, so if the patient is in a critical stage, we have to go to an extension room, which is in the MedSurg. We do not have enough rooms because the hospital was built back in 1986. The recommended capacity for our ICU should be about eight to 10 rooms but we only have four,” he said.

“The MedSurg only has 40 available rooms for their use. Many times, due to the extent of the patient’s illness, the length of stay is significantly long, which causes the holdup and backlog in the room being used. The patient turnover is very low,” he said.

Patient turnover is the rate at which patients are admitted, treated, or discharged from a hospital and is affected by variables such as their length of stay and the severity of their condition.

Average daily census for 2016

The average daily census is the number of patients that are admitted to a hospital. Inpatients occupy beds, units, wards, or anything in the hospital, exclusive of newborns.

According to Tudela, the 2016 average daily census per month has been consistently in the 50’s. This means that for each month of 2016, about 50 patients avail of CHC’s inpatient services daily, with the highest number of patients for the year in November 2016, at 61.1 average daily patients.

January 2016, which yielded an average of 51.52 average daily census, is 3 points less than January 2017’s average daily census at 54.5.

This information implies that there is a constant increase in patients going to CHC for inpatient services.

“The turnover time is not as quick as we want it to be because these patients are really sick. If [the patients] require, say, accelerated tertiary care, we would work with medical referral. Even that is a process; it is a process that requires them to be processed in a fast manner but not as fast as we want it to be. Another factor is the doctors must also be willing to accept the patient,” said Muña.

For 2015, the average census per month is 52, while 2016 yielded 56.

Adjustments

CHC has since been adjusting to the high census.

Because the hospital has been filled up to its capacity, the emergency room, or ER, has been utilized by the hospital as an observation area.

Muña said patients that are approved for discharge are being asked to do so in order to help accommodate the other patients.

“When you have patients that should be discharged, the patient must be discharged on time so that they do not hold the room unnecessarily,” she said.

Muña added that when a patient comes in and requires a room to be treated, options are sought to accommodate the patient, such as asking other patients that have a room to move to the ER if their condition is not as serious.

“It is a different scenario every time. We have even used the pediatric ward to room patients in the hospital. As long as there is no harm and the patient is considered safe, the patient could be moved to a different part of the facility,” she said.

Muña has already sent a proposal for the improvement and renovation of CHC to Gov. Ralph DLG Torres.

The proposal included various improvements and renovations that are much needed by the hospital, such as re-designing the ER, the expansion of the inpatient pharmacy, the repair and renovation of patient room toilets and sinks, the re-designing of the old Family Care Clinic into Chemotherapy Unit, and the expansion and/or renovation of the ICU, Operating Unit, Laboratory Unit, and the Labor and Delivery Unit.

The proposal has a projected total cost of $9 million.

Torres told Saipan Tribune in an email issued by his office that, “The ability of CHCC to meet the needs of the community remains at the top of my administration’s priorities,” he said.

“I have spoken with CHCC officials on the constraints of the current facility and how we can scale to meet the needs of our growing community. I am looking forward to supporting their efforts to enhance their services and improve our community’s health outcomes.”