Munson Leaders Talk Busiest Week Ever, Strategies For Alleviating Capacity Strains

Munson Medical Center (MMC) may have just clocked its busiest week ever.

“Our emergency department (ED) saw 193 patients on Monday alone; I’m not aware of a higher number than that [in hospital history],” says Dr. Thomas Schermerhorn, MMC’s chief medical officer. For reference, Schermerhorn shares that a typical summer day at the ED would see 155-165 patients.

It’s not just the emergency room, either. Brian Lawson, marketing and communications manager for Munson Healthcare’s central region, says MMC “has been running close to capacity all week.

“This is probably as busy as the hospital has ever been,” Lawson tells The Ticker.

What was it about this week that was so exceptional? Munson leaders say it’s not one specific thing, but rather a perfect storm of factors. At the top of the list? The region’s seasonal spike in population, both from tourists and seasonal residents.

“For MMC, the Fourth of July/Cherry Festival week is typically what kicks off our summer,” Schermerhorn says. “That’s when our temperatures – both air and water – finally warm up enough for folks to say, ‘Okay, it’s summer; let’s go to Traverse City.’ And with the increased number of folks here, you're going to have more people presenting to the ED and to the hospital.”

Speaking to The Ticker in 2023, Munson Healthcare Chief Medical, Quality, & Safety Officer Joe Santengelo said that MMC’s ED has typically seen a 40 percent increase in traffic in the summer months compared to the off-season. Even compared to previous summers, though, Schermerhorn and Lawson admit that MMC’s recent traffic numbers have been off the charts.

“We’ve never seen a July quite like this before,” Lawson says. “Certainly, the influx of people coming into the area plays a role in that. But the people that we do have in the hospital also seem to be sicker. We’re seeing a lot of stroke, a lot of trauma, a lot of injury and respiratory illness – not just in Traverse City, but across the system.”

“We had a pretty busy January and February this year, too, so I think it's more than just the visitors,” Schermerhorn interjects. “We’re not seeing the seasonal drop-off that we used to, and because of that, we think there's a demographic shift. As more folks retire here or shift here for late-career, there are more people in the stage of their lives where they’re going to need medical care more frequently.”

If there’s a silver lining, Schermerhorn says, it’s that Munson Healthcare recently rolled out several initiatives to ease capacity strains at MMC. Earlier this month, for instance, the new Grand Traverse Mental Health Crisis and Access Center made the transition to round-the-clock crisis walk-in services – and has since seen a substantial uptick in traffic.

“Our team served a total of 65 people that walked in during the first week [of 24/7 service], and that’s on par with our biggest month ever, let alone our biggest week,” says Terri Lacroix-Kelty, executive director of behavioral health for Munson Healthcare. “So, we've been able to alleviate some of that stress on the ED for people in behavioral health crisis.”

Also launched this month: a new type of telemedicine. Already, Munson leans on telehealth offerings like Virtual Urgent Care and the Ask-A-Nurse hotline to triage patients before they visit the ED. The new telehealth strategy goes one step further, deploying multiple “mobile medical units” (pictured, right) to the ED and other parts of MMC, to “bring telehealth into the inpatient setting.”

Schermerhorn describes each mobile medical unit as “a column with a camera and speaker on the top and a monitor attached,” plus assessment equipment like a stethoscope that allows tele-providers to listen to heart, lung, and abdominal sounds from afar.

The main application of those units is “tele-triage.” Patients who come to the ED with less severe issues can connect with “advanced practice providers” (APPs) via the mobile medical units rather than waiting to be seen by an in-person provider. The APPs, Schermerhorn says, are all Munson-based providers – most of them nurse practitioners or physician assistants – and can assess patients remotely to determine next steps.

“What that allows our ER staff to do is begin initial testing,” Schermerhorn says. “Say, if, through that tele-triage assessment, the APPs identify we need to check a blood count to check for an infection, or we need to order an x-ray to look for a fracture. We can initiate that ordering process early in the patient's presentation, so that when they transition to their in-person evaluation, there's not a delay.”

The new telehealth system currently consists of four mobile medical units at MMC, including two in the ER and two in the main hospital. The units in the hospital are utilized for admissions, with “a second set of virtual providers” standing by to streamline the patient intake process for individuals who have gone to the ED and been determined “suitable for admission.”

“In those cases, we can utilize the platform to perform an admission history and a physical exam, expediting the admission of the patient to our floor and their initiation of their care,” Schermerhorn says.

Just how impactful are these telehealth systems? With two units active in the ED, Schermerhorn tells The Ticker that virtual providers can see “up to 25 patients per shift with this platform.” That number isn’t enough to solve Munson’s current traffic problem, but it’s a start.

“Our volumes right now are 30 percent higher than typical at some points, and in a hospital setting, you can’t usually have staff standing by able to accommodate those surges,” Schermerhorn says. “What the telehealth platform allows us to do – both in the triage and the hospital admissions formats – is flex for fluctuating capacity and allocate resources as the patients present.”

Longer term, Schermerhorn hopes the systems will provide the data Munson needs to better understand its staffing needs in this new, busier era of Traverse City medical care.

“So, if the data shows we're consistently needing to deploy the telehealth platform at such-and-such time of day, that’s a time when we want to ultimately add an additional in-person provider,” he says. “In the meantime, these units are going to help us with the unanticipated surges as we're getting to understand our patient presentation trends a little better.”