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From Dusk Till Dawn
Pager in hand, Hopkins Hospital’s new evening administrator is poised to fix nightly issues

How do you get a patient up from the ED and into a bed? Stacy Sanders can help.

The sun has set, and the pediatric emergency department is hopping. There, the mother of a young patient, distraught over her child’s condition, discovers that on top of everything else, her car’s been towed.

Just then, Stacy Sanders stops by on her hourly rounds. Sanders, it turns out, has the scoop on the company that towed the car; she believes she can help. Making diligent notes in her ever-present leather folder, she gently reassures the grateful mother and apologizes for the inconvenience.

As Hopkins Hospital’s new evening administrator, Sanders is responsible not just for resolving dilemmas like this, but also for developing more efficient systems of patient care. She’s further charged with handling any after-hours emergencies on the East Baltimore campus. In the end, her work points to better, friendlier, safer patient care.

Sanders works a 3:30 p.m. to midnight shift, Monday through Friday, and is also on call from midnight to 9 a.m. on weekdays. Her job, says Ron Peterson, president of Hopkins Hospital and Health System, addresses the considerable growth in the hospital’s activity after 4 o’clock and the need for administrative support during this witching hour, when daytime leaders are scarce.

In the 1970s, the position of evening administrator had been eliminated as a cost-cutting measure. But now, Hopkins has several thousand more admissions annually than even just a few years ago. Many emanate from the ED, which is all too often clogged with cases that need to be moved upstairs. During flu season, the ED can experience a back-up that’s 40 patients deep.

In fact, streamlining the flow of patients from the ED and into beds is one of the most critical—and unquestionably the most demanding—parts of Sanders’ role. “On the surface, this might appear to be an ED problem, but it is very much a hospital problem,” she says. “The volume is getting to the point where organizational priorities may need to be reconsidered. I’m starting to work with each department to identify their areas for improvement and help them communicate with those who can effect change.”

She explains that some of the delay in getting patients into beds is caused by system inefficiencies. But at other times, it’s a matter of timing. For example, the worst build-up in the ED normally occurs around 6 p.m. when most inpatients are discharged. Then there’s a lag as the beds are made ready for the next patients and the nurses are changing shifts. A hold-up at any step in the system bumps the rest of the cases back like dominoes.

“The big question is pinpointing the definition of safety,” says Sanders. “When is it better to keep a patient in the ED until the right bed is ready? When is it better to get them upstairs faster but into less-than-perfect arrangements?”

Sanders is now on a fact-finding mission to help hospital leadership find the answers to questions like these. By spending time with nurses, physicians, shift coordinators, admissions facilitators and housekeepers in all departments, she is observing operations so she can make recommendations. “I’m an objective party looking at all the facts,” says Sanders. “I don’t take sides. I don’t judge. I’m simply here to do anything I can, in real time or for the future, to remove underlying obstacles so that our staff can focus solely on caring for patients.”

A 26-year-old graduate of Dartmouth with master’s degrees in health administration and health outcomes research from Dartmouth and the University of Washington, Sanders is a natural for the position. She’s undaunted by the myriad problems that crop up on every shift—a suspicious package on the subway, supply shortages, a tearful mother in search of a private room for her daughter.

“She doesn’t see herself as, Here I am, I’m in charge of the evening shift,” says Judy Reitz, executive vice president and chief operating officer. “She sees herself as, Here I am, how can I help you? She’s the administrative face of the hospital after hours.”

—Lindsay Roylance




Johns Hopkins Medicine

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