I think the complexity might reflect the continued growth of managed care. The carve-outs for tertiary and quaternary services are contributing a lot of patients. Subspecialty patients, in areas such as kidney, liver or bone marrow transplantation, are increasing faster than the number of patients who come to our two units through the emergency department. We've been told acuity is rising statistically throughout the hospital and that within one to two years this will be primarily an ICU-type hospital. We've been hearing that for five years or so, but it does seem more real now, as if it may really come true.
Patients seem to be clustering on the ends of the continuum.
While we're seeing sicker patients, many programs because of technology are legitimately moving to an outpatient setting - some bone marrow transplant patients, for example. With the higher acuity and a higher census, we clearly need more nurses to take care of patients. We're devoting a great deal of attention to recruiting and orienting nurses and ensuring that all nurses who work here have proper support. We're well prepared. We have an extraordinarily experienced staff - 50 percent of our nurses have been here more than 15 years.