MMHA 6475 Week 2 Program Needs Case Example

Waiting for a Bed: A Needs Case for Hospital-Level Care at Home at Tamarack Health's Flagship Campus

Student Name

Walden University

MMHA 6475: Program Planning, Implementation, and Evaluation

Instructor Name

Month Day, Year

Waiting for a Bed: A Needs Case for Hospital-Level Care at Home at Tamarack Health's Flagship Campus

The Gap

Medical patients admitted through the emergency department at Tamarack Health's flagship campus wait for inpatient beds longer than the system's own standard, and the waits are worst from December through March. Tamarack's standard is that an admitted patient leaves the emergency department for an inpatient bed within four hours of the admission decision. In the busiest months, many patients wait far longer, occupying emergency department spaces needed for new arrivals and receiving inpatient care in a setting not designed for it. This needs case documents the gap with records the system already keeps, describes an external model that could reduce it, and compares that model with two alternatives. Tamarack is an invented system, and every figure below is a labeled slot for the organization's own data or an illustrative value.

What the System's Own Records Show

Three kinds of records describe the gap. Table 1 lists each measure, its source and the form the figure takes in this case.

Table 1

Measures of the Bed Gap and Their Sources

Reading the Records

Boarding hours are the most direct measure of the gap, because they record the time an admitted patient spends waiting for a bed. The monthly pattern matters as much as the annual average: a system whose boarding rises sharply each winter has a seasonal capacity problem, which a flexible solution may address better than permanent construction. National data show that emergency department boarding climbs steeply as hospital occupancy approaches its limit (Janke et al., 2022), and Tamarack's occupancy figures should be read alongside its boarding hours for that reason. When medical units run near full at midnight, a small number of additional discharges or avoided admissions can shorten waits for everyone behind them.

The five conditions were chosen because they account for a large share of medical admissions and because each has been treated in hospital-at-home programs elsewhere. Their length of stay shows how many bed-days a home program could release if some patients with these conditions were treated at home instead. Each record has limits. Boarding time depends on how the admission order time is recorded, which varies by physician. Occupancy at midnight misses daytime surges. Length of stay reflects discharge delays as well as clinical need. The case uses all three together because no single one describes the gap on its own.

External Evidence: Hospital at Home

The hospital-at-home model was developed at Johns Hopkins under the leadership of Bruce Leff and colleagues. Its core proposition is that some acutely ill adults who already qualify for admission can be treated to inpatient standards without leaving home, with physician oversight, nursing visits, monitoring and the ability to deliver medications, oxygen and diagnostic tests at home. In the original multisite study, older patients treated at home had care that met hospital quality standards, with shorter episodes and fewer complications such as delirium than comparable inpatients (Leff et al., 2005). A later randomized trial at two academic hospitals found that home hospital care cost less and was associated with fewer readmissions within 30 days, with patients spending more time physically active (Levine et al., 2020).

For Tamarack, the model's appeal is that it adds acute capacity without adding beds. Each patient treated at home is one fewer patient waiting for a medical bed. The evidence does not show that every system can reproduce these results, and both studies selected patients carefully; the planning that follows has to define who would be eligible at Tamarack and what would count as success.

Alternatives Considered

Adding inpatient beds. Tamarack could open a new medical unit at the flagship campus. This addresses the gap directly and year-round, but it requires capital for construction or conversion, takes years to complete, and would add permanent staffing costs to meet what is partly a seasonal peak. In a tight nursing labor market, a new unit may also be hard to staff.

An observation unit. Tamarack could convert space near the emergency department into a short-stay observation unit for patients expected to need less than two days of care. This would take some short stays out of medical beds and is quicker to open, but it helps mainly patients with brief stays, not the heart failure and pneumonia patients whose longer stays drive occupancy. Observation status also carries different billing and patient cost-sharing rules, which some patients find confusing.

Hospital at home. The home model adds capacity that can scale with demand, uses existing staff categories and serves the conditions that drive occupancy. Its risks are operational: it depends on logistics, staffing for home visits and payer agreements, and it serves only patients who meet eligibility criteria and live within reach.

The case does not claim the home model is the only answer. Tamarack may need an observation unit as well. It argues that the home model fits the gap's seasonal, condition-specific pattern and deserves a planning effort to test that fit.

What Planning Must Settle Next

Three questions follow from this case and shape the objectives in Week 3. Which patients, by condition, severity and home circumstances, would be eligible? How many eligible patients could Tamarack expect each winter, given referral patterns and patient acceptance? And what result would show that the program is helping: fewer boarding hours, freed bed-days, or outcomes for the patients treated at home? A program planned around boarding hours alone could succeed for patients and still fail to move the system's numbers, so the objectives will need to address both.

References

Janke, A. T., Melnick, E. R., & Venkatesh, A. K. (2022). Hospital occupancy and emergency department boarding during the COVID-19 pandemic. JAMA Network Open, 5(9), Article e2233964. https://doi.org/10.1001/jamanetworkopen.2022.33964

Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Inouye, S. K., Greenough, W. B., III, Guido, S., Langston, C., Frick, K. D., Steinwachs, D., & Burton, J. R. (2005). Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of Internal Medicine, 143(11), 798-808. https://doi.org/10.7326/0003-4819-143-11-200512060-00008

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600