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Hospital Seeks an Upgrade for Patients

Nurse manager Nadine Dietrich in one of Laguna’s underused ICU rooms.

Nurse manager Nadine Dietrich in one of Laguna’s underused ICU rooms.

Mission Hospital will seek permission of state Public Health Department regulators to allow admitted patients to recover in under-used private rooms of the intensive care unit in the Laguna Beach campus.

City officials who last week learned of the initiative initially feared that hospital administrators intended to close the unit altogether, which would also trigger the closure of the emergency room, a service city officials have staunchly demanded remain intact.

No such cutbacks are envisioned in Laguna’s 207-bed facility, administrators say, though hospital leaders next month plan to retool a 10-year master plan for the campus, which may change future areas of emphasis.

“We know the ER is first and foremost,” Kenn McFarland, Mission’s chief executive, said in an interview Monday. “The ER room and support services, behavioral health and chemical dependency and outpatient services; that’s the bedrock of everything,” he said.

About 30 patients a day are treated in Laguna’s emergency room and most go home, said Linda Johnson, chief clinical officer of Mission, whose license covers both campuses in Mission Viejo and Laguna. Mission is part of St. Joseph Health, based in Orange.

Rarely do more than two patients at a time require intensive critical-care monitoring, though 10 private rooms in the Laguna hospital are designated for that purpose, she said.

Hospital administrators want the flexibility to place admitted patients in the preferred, single-occupancy rooms in the ICU unit if they are unoccupied, since all but one of the 15 third-floor rooms where patients typically recover from surgery or illness are semi-private. Ocean views are visible from almost every room, including the behavioral health floor and chemical dependency unit run privately by Mission Pacific Coast Recovery.

When Laguna’s acute-care rooms fill up, new patients can’t be admitted and must transfer to the larger 552-bed sister campus in Mission Viejo, said spokeswoman Tamara Sharp.

“We have beds in ICU we are desperate to use,” said Nadine Dietrich, nurse manager of cardiac monitoring in Laguna’s ICU and med-surg floor, which often reaches capacity. Earlier this month, she described having to refuse a request for a private room from the family of an end-of-life patient in her 80s. “It would have been optimal to move them in,” she said.

While top hotels and restaurants take pains to satisfy guest whims, hospitals, under pressure to contain costs, monitor patient experiences for reasons other than loyalty. Private rooms are more therapeutic and less stressful because there are fewer interruptions, family can camp out, roommates don’t overhear sensitive conversations and sleep cycles are less disturbed, Dietrich said. “They optimize their care,” she said, which ultimately can result in shorter hospital stays.

“Our goal is to enhance the patient experience,” said Johnson, adding that regulators have approved similar measures at other facilities. “We know patients want private rooms.”

Laguna’s ICU receives fewer patients in part because Mission Viejo is the region’s designated trauma center, which also receives emergency stroke and cardiac cases.

Hospital administrators say they have informally appealed to regulators. Public Health Department spokesman Corey Egel said the department has not yet received any requests on the issue. “We’re just having the dialog,” Johnson explained.

Since acquiring the former South Coast Medical Center in 2010 for $35 million, Mission administrators have invested $21 million in renovations, including replacing a noisy heating and cooling system and expanding the behavioral health unit from one floor to two. The hospital’s fifth floor, which housed a long-term care facility, remains empty, Sharp said.

An earlier plan to establish an orthopedic specialty within the Laguna hospital was rendered obsolete as a result of St. Joseph’s recently announced affiliation with Hoag Hospitals and the acquisition of a medical group with 11 specialists, McFarland said. The alliance reflects pressure on health care providers to contain costs and locally is intended to allow residents ubiquitous and seamless access to Hoag and St. Joseph practitioners throughout the county. “We didn’t feel we’d be acting responsibly,” he said, by replicating in Laguna an existing orthopedic specialty at Irvine’s Hoag Hospital, which patients of Mission doctors can now use.

McFarland expects to finalize a re-vamped plan and announce later this year what’s envisioned on the Laguna campus by 2020.

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