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Research highlights Minn. ED backlog due to unnecessary patient care

In a five-month period, patients spent 65,000 more days than needed in hospital inpatient beds


Patients were treated in hallways and on gurneys in the emergency department at St. John’s Hospital in Maplewood in 2022. Overcrowding in hospitals has created delays and left patients waiting in ERs.


By Jeremy Olson
Star Tribune

SAINT PAUL, Minn. — One in six days of inpatient care is unnecessary now in Minnesota hospitals — a level of inefficiency that is causing backlogs in emergency departments and leaving patients waiting hours to receive treatment.

The Minnesota Hospital Association issued that finding Wednesday after surveying 101 hospitals across the state and discovering that a backlog, which emerged during the pandemic, is becoming a permanent problem. Patients spent 65,000 more days in inpatient hospital beds than needed in the five-month period ending in October — after the COVID public health emergency had ended.

“We cannot have this become the new normal for our patients across the state and in all of our communities,” said Dr. Rahul Koranne, president and chief executive of the trade group for the state’s hospitals. “The sheer magnitude of the number of patients stuck up in the [hospital] units is immense and it is backing up the entire system.”

A loss of 3,000 nursing home beds in Minnesota since 2020 has left hospitals with nowhere to send patients who are ready to leave but still need rehabilitation services before they can go home. The backlog is costly for hospitals, which don’t get paid by insurers for unnecessary inpatient care, and frustrating for patients who suffer delayed treatment.

Melanie Wickersheim, a heart and kidney transplant recipient, said she endured delays getting into the emergency room at M Health Fairview’s University of Minnesota Medical Center last week, despite severe vomiting and diarrhea.

The medics who brought her by ambulance were surprised as well, she recalled. “They were looking at the clerks like, ‘Aren’t we going straight back?’”

Wickersheim said her health stabilized once she got beyond the ER waiting room and she received medications and fluids, but that the delay prolonged her discomfort. The 39-year-old Minneapolis woman then remained in the ER for three days, because no inpatient beds were available, which in turn left other patients sitting in the waiting room or receiving emergency treatment in the hallways.

“It feels like a crisis,” she said. “I’ve been a patient for a long time, going in and out of emergency departments ... and I’ve never experienced this before.”

Lawmakers offered solutions last year, including $300 million to keep nursing homes open and $18 million in one-time funding to compensate hospitals for their boarding of patients stuck in inpatient beds in the first half of 2023.

Koranne said the nursing home funding should help by allowing facilities to hire more staff and take more patients from hospitals. However, he said, hospitals need longer-term financial relief as well, including an increase in payment rates from the state’s Medical Assistance program, to overcome the financial losses of boarding patients ready to be discharged.

“The hospitals are getting forced into a corner and have to make some very tough decisions about how to keep themselves open,” he said.

Newly released financial data for Minnesota’s hospitals showed that 43 of 118 had negative operating margins in 2022.

Other solutions include the expansion of inpatient rehabilitation facilities that could take more patients from hospitals. A Texas for-profit company wants to build a 60-bed facility in Roseville, but first needs lawmakers to grant it an exception to the state’s hospital construction moratorium.

M Health Fairview responded to overcrowding at St. John’s Hospital in Maplewood by opening a new 16-bed short-stay unit that can free up ER space by taking patients who don’t need prolonged hospital stays.

Fairview in a written statement did not address Wickersheim’s experience but said overcrowding and ER backlogs have caused “staggering financial losses” and disrupted patient care. Solutions are needed outside of hospitals that prevent medical emergencies and reduce patient demand, the statement said. “This is not something we can do alone.”

State Sen. Kelly Morrison, DFL-Deephaven, said she is offering legislation to financially support hospitals for the cost of boarding, which is “terrible for patients who are left having to literally live in a hospital.” But State Rep. Tina Liebling, DFL-Rochester, said she is uncertain about the solution.

“No doubt extra money would be helpful to hospitals,” she said, “but I don’t see how it solves the patient flow problem.”

The overcrowding is most severe in the Twin Cities, where weekly hospital reports show that 99% of inpatient medical and surgical beds are occupied most days.

Allina Health responded in 2022 by putting United Hospital in St. Paul and Regina Hospital in Hastings under one license, making it easier to transfer patients between them to free up space. Overcrowding has remained a problem at the St. Paul ER, though, which set a record in December when it treated 5,500 patients.

“The patient in the emergency department who needs to get up in the unit, can’t,” Koranne said. “The patient in the ambulance who needs to get into the emergency department, can’t. It’s backing up the entire system.”

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