Most of my childhood was spent in nearby Silver Spring. While there is much about Silver Spring that I remember most fondly, when I was a child, I thought it was a rather bland community. I wished then that I could have lived in someplace interesting, someplace people went to as a destination, not by default. Ah, the ignorance of youth.
I was waiting in a fancy chair in a dark, exquisitely decorated room in Baltimore’s historic Clifton Mansion, taking a last-minute glance at the questions I had prepared for a VIP. I had been going back and forth with press people for months for an interview and credentialing and now it was finally happening. I knew I probably only had 10 minutes or so to talk, a limited time I’d usually protest.
When it comes to transportation — like most policy issues of importance — elected officials have basically two options moving forward: They can take the easy road or the hard one. The former requires no difficult decisions; often it just requires kvetching about how you’ve been shortchanged. The latter means challenging your supporters to make meaningful choices — cutting projects or raising taxes and fees.
Imagine this: a young Maryland mother is rushed by EMS to a nearby emergency department after a severe car crash, a store clerk arrives after being struck by a stray bullet on his way to work, and a man suffers a heart attack on a nearby street corner. All three arrive at the hospital within minutes of each other, all needing critical care. The emergency department (ED) has only one available bed.
Jennifer, an ED nurse, and her team are stretched because they know there is also a person with a severe migraine who has been facing intense pain and throwing up for two days and an elderly person who fell. Both have been waiting over two hours for care. Despite these challenges, Nurse Jennifer and the rest of the ED team roll up their sleeves and get to work saving lives and providing comfort.
Hospital teams face tough decisions—not just about who to treat first, but how to manage an overwhelming and unpredictable influx of patients with limited resources.
Throughput is a critical issue across the nation. The complexity of managing patient care and flow while ensuring high-quality care means that hospitals must continuously adapt and innovate. Despite the best efforts of health care professionals, wait times remain a significant challenge in Maryland, exacerbated by factors beyond the control of hospitals, such as a limited number of hospital beds across the state, a lack of behavioral health and primary care, issues with post-acute care referrals, and payer denials.
Maryland hospitals have not stood idle. Through collaborative efforts like the statewide Maryland Hospital Association Hospital Solutions Collaborative, the General Assembly Hospital Throughput Work Group, and the Health Services Cost Review Commission’s (HSCRC) Emergency Department Dramatic Improvement Effort (EDDIE project), significant strides are being made. Several innovative approaches have emerged as best practices—reducing ED congestion while improving wait times and patient experience.
Impactful hospital initiatives include:
In addition, there are many other emergency department-based programs including palliative care, patient navigators, social workers, and community health workers to support needs far beyond the patient’s hospital stay. Follow-up appointments are set, and patients and their caregivers are educated so they have the tools to care for themselves at home. While these processes may actually add to the length of time spent caring for a patient, they ensure each person is safe to go home with the hope that they can avoid readmission.
Back to Nurse Jennifer and her team, they quickly work to stabilize the gunshot victim while getting him to an operating room. The heart attack victim is rushed to the cardiac catheterization lab where a dedicated care team begins life-saving treatment. The expediting team quickly evaluates the young mother. They find she is suffering from severe traumatic brain injury, and she’s immediately sent in for surgery. Of all the patients mentioned, only the young person with the migraine can be treated (in vertical care) and discharged. Though critical patients get immediate care from the ED doctors, nurses, and others, there are no hospital beds to move them to when their procedures are complete.
At the same time, the elderly fall patient has a slight pelvis fracture and cannot be released to his home. It is now past 8 p.m., and there is no way to get the patient’s insurance carrier to approve a move to a skilled nursing facility.
While hospitals are hard at work, there are numerous factors outside of their control that must be addressed at the same time. Access to community-based care, including primary care and behavioral health and substance use disorder services, must be expanded to reduce the burden on emergency departments. Additionally, the post-acute care sector faces workforce shortages, making it difficult to discharge patients who need longer-term support in a timely manner. Matters are made worse by the administrative burden and time associated with denials from insurance companies, especially for patients who are cared for in hospital emergency departments on evenings and weekends.
To address these challenges, we need enhanced capacity in post-acute care environments and a streamlined process for denials from payers. Denials and pre-authorizations make it difficult for hospitals to find the necessary aftercare environments for patients who are medically able to leave.
Progress is being made by hospitals around the state, but we know there is still work to be done across the health care continuum to improve throughput challenges that slow and delay ED discharges. By addressing the broader systemic issues, we can ensure that all Marylanders receive timely, high-quality care when they need it most.
The Maryland Hospital Association
The Maryland Hospital Association (MHA) represents more than 60 hospitals across the state. Composed of community, teaching, and specialty hospitals and health systems and aligned with the American Hospital Association, MHA aims to build healthy communities through healthy hospitals.
Most observers in Baltimore County are wondering who will be the next county executive if Johnny Olszewski wins his congressional election in November, which it looks like he will. However, the better question at the outset is what traits the next county executive should have — and what issues they should be focusing on. The stakes of this appointment are extraordinarily high. The county is facing difficult choices when it comes to next year’s budget, such as how it will pay for increasing costs for health care and pension obligations and the implementation of the Blueprint education plan without reliable funding streams. (Photo: Baltimore Sun)
Earlier this year, Gov. Wes Moore proudly announced that Maryland has raked in record tax receipts from legalized medical and recreational use marijuana sales. “Our new adult-use cannabis market isn’t only generating extraordinary economic activity — it’s also helping us build new pathways to work, wages, and wealth for all,” Moore said, according to the upbeat press release issued in July by his office.
In the next few weeks, Maryland officials are expected to deliver comprehensive plans for how state agencies will tackle the growing climate crisis and deliver on Gov. Wes Moore’s promise to achieve zero emissions across all of the state’s key sectors in the next two decades. In June, Moore issued an executive order that set a Nov. 1 deadline for these detailed implementation plans as the next phase of a 2023 report called the Climate Pollution and Reduction Plan (CPRP).
You could hear the spittle fly as the Heritage Foundation shouted out its latest intellectual assault on the Naval Academy. All over Ruth Ben-Ghiat and a lecture the midshipmen likely will never hear. She’s a New York University historian with a book on what happens to the military when authoritarians take power. She shows up as a commentator on MSNBC, connecting former President Donald Trump to some of the dictators she’s studied.
With just 1% of the country’s 112,000 real estate businesses led by diverse entrepreneurs and leaders, the Diversity in Commerce Real Estate (DCRE) conference, now in its sixth year, remains one of the few spaces where companies, investors, and electeds come together to highlight development opportunities and on ramps for new entrepreneurs in the field. This summer, Gov. Wes Moore served as the keynote speaker for the annual convening in New York City, amplifying the important message that Maryland and Baltimore are open for investment.
In April, more than five tons – about the weight of a large pickup truck – of prescription medicines were collected in Maryland through the Drug Enforcement Agency’s (DEA) biannual National Prescription Drug Take Back Day. On Saturday, Oct. 26, the DEA will host another Take Back Day. While this program is a good start, secure medicine disposal is a year-round need that encompasses both prescription and over-the-counter medicine. Luckily, Marylanders don’t have to wait until Oct. 26 to conveniently dispose of household medicines.