2021 Calendar Year Utilization Report

2021 Utilization Indicators Report FINAL.pdf

The charts and tables in this publication are intended to provide aggregate and comparative data on health care facility utilization in the District of Columbia. The source of the data is the District of Columbia Hospital Association’s Monthly Utilization Survey (self-reported by individual facilities).

Thank You Hospitals, Nurses and all Health Care Workers

May is a month to celebrate and honor our hospitals, health care workers and nurses who have sacrificed so much in the last few years. Nurses are the heart of heath care and hospitals help miracles happen! The District of Columbia Hospital Association loves our DC health care community!

Every day, more than 30,000 dedicated health care professionals go to work in DC hospitals. Thank you to all the HEROES working to take care of us – no matter what!

#HospitalProud #NursesWeek


XFERALL Behavioral Health Collaborative Approach and 988 Crisis

For decades, it has been commonly understood that individuals experiencing a medical emergency shouldn’t wait for treatment. Treatment guidelines for individuals experiencing heart attacks, strokes and traumatic injuries prioritize rapid response. The medical community refers to the “golden hour” — the 60 minutes within which an injured or sick person should receive definitive treatment from the time of injury or onset of symptoms. If care is delayed beyond this hour, the risk of serious, long-term complications or death significantly increases. New systems of care, often regionalized, emerged to ensure that no precious time is lost in transporting, stabilizing, treating, and transferring patients.

Yet, for people experiencing a psychiatric or substance use emergency, a similar urgency coupled with system change hasn’t prevailed. Even in 2022, too many hospitals, crisis teams, first responders, and others needing to get people into behavioral health treatment quickly must rely on outdated, manual processes to locate clinically appropriate care, which cause critical delays in care. In their search for placement, clinicians are calling behavioral health facilities and programs one-by-one, leaving messages, faxing paperwork, and waiting for calls to be returned. The seemingly simple act of transferring a patient to behavioral health care is requiring clinicians to spend countless hours on repetitive administrative tasks that take them away from direct patient care.

The result is that, far too often, children, adolescents, and adults experiencing a behavioral health crisis wait hours or even days for placement in clinically appropriate therapeutic treatment. One study documents an average length of stay in the hospital emergency department for psychiatric admissions of 18 hours, compared to 5 hours for non-psychiatric admissions.1 Others have estimated average boarding times of between 6.8 hours and 34 hours for patients needing psychiatric treatment.2,3

Today, these wait times are likely even longer as the pandemic has made the ED boarding crisis worse in two ways. One, hospitals are at or beyond capacity with patients with COVID-19 and other serious physical conditions coupled with ever increasing staffing shortages. Two, the pandemic, and the associated anxiety, stress, and isolation, have contributed to an increased need for behavioral health care, particularly among children and adolescents. Children’s hospitals reportedly saw a 45 percent increase in pediatric self-injury and suicide cases between January and July 2021.4 In 2020, pediatric mental health-related hospital emergency department visits increased 24 percent for children ages 5-11 and 31 percent for older children and adolescents.5

XFERALL’s mission is to drastically save time for clinical staff and reduce the amount of time patients spend in EDs waiting for a transfer to the most appropriate care center by applying innovative technology solutions. The platform enables real- time communication so that clinicians needing to place a patient can request placement at as few or as many facilities as they choose; receive responses from facilities or programs that can accept and treat the patient; and share clinical information — all within minutes and within a single source. This coordinated approach allows caregivers and patients to be engaged in the decision-making process as well.

The District of Columbia Hospital Association and XFERALL, the nation’s leading mobile patient transfer platform, have entered a partnership that offers DC hospitals a new process for transferring acute and behavioral health patients to clinically appropriate health care facilities. To learn more, join us on May 10 for a free webinar, Behavioral Health Patient Transfer & Placement Technology, and learn about this program and how it can support improving access for patients in crisis.

XFERRAL Webinar Graphic

1 Nicks BA, Manthey DM. The impact of psychiatric patient boarding in emergency departments. Emerg Med Int 2012; 2012: 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Patient and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Ann Emerg Med. 2012;60(2):162–71.

3 Tuttle GA. Access to psychiatric beds and impact on emergency medicine. Chicago, IL: Council on Medical Service, American Medical Association; 2008.

4 Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health, October 19, 2021.

aacap.org/aacap/zLatest_News/Pediatricians_CAPs_Childrens_Hospitals_Declare_National_Emergency_Childrens_ Mental_Health

5 Ibid

February 2022 Utilization Report

Utilization Report - February 2022.pdf

Highlights: Analysis of utilization metrics relative to pre-COVID baseline shows a continued decrease of acute care admissions this month as they now stand at 23% below pre-COVID baseline, and emergency department visits still on the downward trend at 39% below baseline. Conversely, there is an uptick in ambulatory surgeries and psychiatric admissions this month, with a 17% and 8% increase respectively. The psychiatric admissions increase is reflected in the bottom graph on page 15 of the report, which depicts all but one hospital observing a higher volume.



January 2022 Utilization Report

Utilization Report - January 2022.pdf

Analysis of utilization metrics relative to pre-COVID baseline shows a decrease of acute care admissions, with the lowest volume over the last 13 months and currently at 19% below pre-COVID baseline. While emergency department (ED) visits also took a dip this month, along with ambulatory surgeries at respectively 32% and 25% below baseline (See Fig. 1 on front page of report), psychiatric admissions are the only metric to show a slight increase and standing at 36% below baseline. Observation admissions appear to be following the same trend as acute care admissions and ED visits with a lower volume as depicted in Chart 7 of the report.



Top 10 De-Escalation Tips for Health Care Professionals

Every day at the workplace presents new encounters, situations, and challenges for the health care professional. You may find yourself dealing with angry, hostile, or noncompliant behavior every day. Your response to this defensive behavior plays a critical role in determining whether or not the incident will escalate into a crisis situation. These 10 de-escalation tips provide strategies and techniques to help you respond to difficult behavior in the safest, most effective way possible.

  1. Be empathetic and nonjudgmental
  2. Respect personal space
  3. Allow time for decisions
  4. Use nonthreatening nonverbals
  5. Set limits
  6. Focus on feelings
  7. Ignore challenging questions
  8. Avoid overreacting
  9. Choose what you insist upon wisely
  10. Allow silence for reflection

DeEscalation Tips for Health Care

Donate Blood – The Red Cross is Experiencing the Worst Blood Shortage in a Decade

The Red Cross is experiencing the worst blood shortage in over a decade. Low blood supply levels can force hospitals to defer patients from major surgery. Blood donation is desperately needed.

General Messaging

  • The current blood crisis is the worst in the past 10+ years.
  • The Red Cross continues to have a need for blood donations to ensure hospital patients in our community continue to receive needed care for treatments, such as transfusions for those battling cancer. All blood types are needed, especially types O+ & O-.
  • Please head to RedCrossBlood.org to find the next available appointment to donate.
  • The Red Cross, which supplies 40% of the nation’s blood supply, has had to limit blood product distributions to hospitals as a result of the shortage. In fact, some hospitals may not receive 1 in 4 blood products they need.
  • Blood cannot be manufactured or stockpiled and can only be made available through the kindness of volunteer donors.
  • You can save three lives in 15 minutes.

What is Causing the Blood Shortage Crisis?

  • Overall blood donations have declined by 10% since March 2020.
  • There has been a 62% drop in college and high school blood drives due to the pandemic. Student donors accounted for ~25% of donors in 2019 accounted for just ~10% during the pandemic.
  • There are ongoing blood drive cancellations due to illness, weather-related closures and staffing limitations.

Critically Needed Blood

  • Type O positive is the most transfused blood type and can be transfused to Rh-positive patients of any blood type. 38% of the population has O positive blood, making it the most common type.
  • Type O negative is the universal blood type and what emergency room personnel reach for when there is no time to determine the blood type of patients in the most serious situations.
  • Platelets are the clotting portion of blood, which must be transfused within five days of donation.
    • Nearly half of all platelet donations are given to patients undergoing cancer treatments

Reasons to Give Blood

  1. 1/3 of us will need a blood transfusion in the future
  2. 3 lives can be saved with the amount of blood donated in one sitting
  3. Every two seconds someone in the United States needs blood
  4. 36 hours is the time it takes to naturally replace blood lost from the body

Call to Action

  • Make sure people know where and how to donate blood.
  • Go to redcross.org to learn how to give.

Sources: American Red Cross, Give Blood, One Blood

Sample Graphics



The Joint Commission Releases Requirements for COVID Vaccination of Health Care Personnel

On February 16, 2022, The Joint Commission shared required documentation for COVID vaccination among health care staff.  The Joint Commission will now be requiring health care facilities to provide the following documentation:

  1. Overall COVID vaccination rate of eligible staff
  2. A list of all staff, including positions/titles, including COVID vaccination status
  3. All policies regarding health care staff COVID vaccinations
    • Policies for COVID vaccination exemptions
    • Policies for COVID vaccination requirements
    • Policies for mitigation of unvaccinated staff
  4. List of newly hired staff in last 60 days

New Requirements

  • A process for tracking and securely documenting the COVID-19 vaccination status of all staff.
  • A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC.
  • A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable federal law.
  • A process for tracking and securely documenting information provided by those staff who have requested, and for whom the organization has granted, an exemption from the staff COVID-19 vaccination requirements based on recognized clinical contraindications or applicable federal laws.
    • Surveyors will not assess the appropriateness of clinical contraindications or religious exemptions.
  • A process for ensuring that all documentation that confirms recognized clinical contraindications to COVID-19 vaccines and supports staff requests for medical exemptions from vaccination has been signed and dated by a licensed practitioner who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable state and local laws. Such documentation contains:
    • All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive the recognized clinical reasons for the contraindications.
    • A statement by the authenticating practitioner recommending that the staff member be exempted from the organization’s COVID-19 vaccination requirements for staff based on the recognized clinical contraindications.
    • Surveyors only evaluate that the documentation is complete; they do not assess the appropriateness of clinical contraindications or religious exemptions.

Vaccination Rate Calculation

  • Numerator Includes
    • Pending religious or medical exemption (during first 30 days of implementation)
    • Approved religious or medical exemption
    • Persons having an approved CDC temporary delay for vaccination
    • Persons with clinical contraindication to receiving COVID vaccine
    • Staff who have received at least one dose of a vaccine should be placed in the numerator of the calculation during first 30 days
  • Who Must be Vaccinated?
    • Facility employees
    • Licensed practitioners
    • Students
    • Trainees
    • Volunteers
    • Contracted staff
    • Staff who perform duties offsite (e.g., home health) and to individuals who enter CMS regulated facilities (i.e., a physician with privileges in a hospital who is admitting and/or treating patients onsite)

December 2021 Utilization Report

Utilization Report - December 2021.pdf

Analysis of utilization metrics relative to pre-COVID baseline shows a slight but consistent decline of acute care admissions from July 2021 to December 2021. This month there was also a noted decline in numbers for other metrics, notably psychiatric admissions, observation admissions and specialty care admissions this month – with three out of five hospitals seeing their lowest numbers for the last 15 months (Table 4). This is all reflected in Fig. 1 below with emergency visits, psychiatric admissions and acute care admissions decreased below pre-COVID baseline to 19%, 37% and 14% respectively. Although observation admissions have been going down, they are hovering around 6% of baseline recovery.

DCHA Partners with XFERALL to Provide DC Hospitals Access to a Solution to Accelerate Transfers of Medical and Behavioral Health Patients

The District of Columbia Hospital Association (DCHA) and XFERALL, the nation’s leading mobile patient transfer platform, have entered a partnership that offers DC hospitals a new process for transferring acute and behavioral health patients to clinically appropriate health care facilities.

The District, as is the country, is experiencing a high volume of behavioral health patients, which results in an increased need for crisis services. DCHA and XFERRAL both recognize the importance of a collaborative approach to creating innovative solutions with diverse partners to support behavioral health access.

XFERALL reduces transfer times for medical and behavioral health patients between health care facilities.

This is one of many projects DCHA works on to ensure behavioral health needs are being met. DCHA works on many initiatives that focus on serving the behavioral health community.

“Partnering with XFERALL on this important effort provides our members with an additional tool to continue our commitment to safe, high-quality patient care for all of the individuals our hospitals serve,” said Jacqueline D. Bowens, President & CEO, DCHA.

XFERALL’s partners in other states have achieved reductions in wait times for transfer to appropriate care by as much as 86 percent.

“We’re excited to bring our innovative platform to DC hospitals to help reduce wait times for essential medical and behavioral health care,” said Nathan Read, CEO, XFERALL. “Too many patients in crisis are waiting too long for care. We know that outcomes are better when patients care is not delayed and is accessible in their community. In partnership with XFERALL, DC hospitals are working to deliver solutions that address the serious challenges of crowded emergency departments, clinician burnout, and delays in care.”

DCHA is the unifying voice for hospitals and health systems in the District of Columbia and works to advance health policy to strengthen the District’s world-class health care system to ensure that it is equitable and accessible to all.

© 2022. District of Columbia Hospital Association.