The Inside View of Hahnemann Closure
“The closure of Hahnemann has been a tragedy for all of Philadelphia, but it’s also an abject lesson that we cannot wait for a solution to come to us. Hope is not a strategy.”
Fortunately, we were up to the challenge of quickly developing many effective strategies to treat the large numbers of Hahnemann patients who have turned to us, and the medical residents who needed to find a new home.
“Jefferson officially had a week’s notice to react and respond to this health crisis, and I think we did the right thing. We formed committees, reached out to contacts at Hahnemann, and worked with our leadership to develop strategies and ways to improve our efficiencies in our very busy hospitals—and we have done so seamlessly.”
“We are blessed to have such incredible staff who are always able to come together quickly, identify and prioritize what needs to be done and then get it done. We started analyzing and planning for this when we heard rumors about this closing. We began by having our Strategy and Business Development team do a zip code analysis of areas surrounding Hahnemann. This allowed us to project the volume of patients and new doctors we would need to help accommodate our swelling patient load, and limit, to a reasonable level, the burden on our existing staff.
“As a result of this closing, we have on-boarded more than 150 support staff from Hahnemann; we care about our patients but also the employees affected by this closure.”
The two areas immediately identified as priorities to provide additional staff and resources to accommodate more patients were Emergency Medicine and Maternity. This offered opportunities to Hahnemann physicians and residents who needed a place to practice and continue their educations.
“Jefferson’s emergency department has seen a significant increase in EMS volume and walk-in patients. We have had to reconsider our ED staffing to safely care for the influx of patients. Within the emergency medicine residency, we have absorbed the largest contingency of residents within Thomas Jefferson University Hospital. This was a huge undertaking which required planning and organization.”
“A lot of my co-residents and I were heartbroken. We’d really come to love Hahnemann, and of course there’s the added question of, ‘What are we going to do next?’ The great thing about Philadelphia is that there are so many hospitals and opportunities for specialty medicine. I got a handful of offers and decided to come back to Jefferson. It’s a great institution, a great hospital, and I’m excited to be able to continue practicing emergency medicine here.”
“At Abington Hospital we have a robust teaching program that includes Drexel University School of Medicine medical students, residents and fellows who participate in rotations from Hahnemann. When learning that these residents and their supervising faculty members would have to resign because of the closure, our leaders had two weeks to develop a plan for the transition of nine medical services and one intensive care service involving 120 patients. We decided to fast-forward the implementation of a new medical model, used the guiding principles of crisis management and assembled a team of talented individuals. We put patients first during this critical time and once again brought to life our mission of Improving lives.”
Crucial to Thomas Jefferson University Hospitals being able to serve its increased patient volume quickly and efficiently was our partnership with the City of Philadelphia and its various agencies.
“We worked with the city’s PA Department of Health to expedite approval for renovations of an unoccupied nursing unit for maternity patients, as well as a former ICU unit for ‘extended stay’ patients from the ER, while the determination was made as to whether they could go home or should stay for overnight observation. Providing ease of access for Fire Rescue was critical. To manage the increased flow of ambulance traffic to the ER, we worked with the Philadelphia Parking Authority to remove obstructive parking spaces near the ER, and assigned security there to guide arriving paramedics.”
“Having the doctors adapt and be mobile to meet patient needs regardless of spacing or room constraints has been key. We have instituted a new physician position called ‘Vertical Attending,’ which is a doctor able to be flexible and go wherever they’re needed to provide an additional pair of hands to treat a critical patient or to decompress some of the patient volume buildup in the fast-track rooms. As a result, they and their patients can move in and out of those rooms quickly.”
“There are often eight, nine or 10 ambulances lined up and arriving one after the other. How well those patients are processed and cared for has been amazing. We’ve also opened up more ‘fast-track’ rooms so that we can treat more lower-acuity patients sooner. In the past, we had discharge bays in the back of the ER and evaluation/ treatment bays in the front. Now, we have reversed this to make the front area near our entrance calmer and quieter.”
Jefferson has adapted impressively over the summer to the new patient volume resulting from Hahnemann’s closure, but there will be more challenges in the future.
“The volume of flu patients during the coming months is something we must anticipate. I think the fact that we’ve had a few months before flu season to adapt and take on and train additional staff and residents, while optimizing how we manage patient flow in the ED to best accommodate our increased patient volume is extremely helpful.”
“The Hahnemann closure highlights a larger problem. Whether you have commercial payers or a single-payer system, if there is not enough reimbursement for care to pay the bills, health systems simply cannot stay afloat. At the end of the day, the Hahnemann closure represents a failure of society to cover the necessary costs of care for our citizens. It is critical that someone pays for the costs of care before another hospital has the same fate.”
Nevertheless, that prognosis does not diminish Jefferson’s achievements in the aftermath of Hahnemann’s closure – or its future resolve.
“The closure of Hahnemann Hospital was a sad day in Philadelphia, as a 171-year-old institution ceased to exist. Our response has been to ensure that the people of our community who were served by Hahnemann can continue to access and receive high-quality care. This has required sometimes-Herculean efforts by our staff who have uniformly risen to the occasion and managed the stressors successfully with empathy and quality.”
But the undiminished morale and commitment of Jefferson’s staff bodes well for the future health of patients in Philadelphia, regardless of the increased volume.
“We are incredibly proud of our own providers and staff who have leaned into this crisis with a positive, caring spirit that underscores our commitment to putting patients first and doing the right thing. We remain firmly committed to providing safe, high-quality care to all of Philadelphia’s residents while shepherding the resources required to thrive in this new environment.”