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Beyond the Four Walls of a Hospital

Beyond the Four Walls of a HospitalA hospital stay can be difficult for both the patient and their family.  And when the next step involves moving beyond the four walls of the hospital to a post-acute facility, the placement can be both time consuming and stressful—even if the patient is staying within the health system.

From the patient’s perspective, they may still be quite ill and want to transition easily to the next step in their treatment plan.  From the health system perspective, they also want to help the patient who is ready to leave—and consequently open up that acute care bed for the next patient that needs it.

We know that patient flow technology has the power to streamline processes and improve the patient experience within both the acute care and outpatient settings, but can it be just as impactful outside the walls of the hospital and in the community?

The benefits are clear when a patient moves effectively and efficiently through the healthcare system, so the hope is that by extending this approach to the post-acute space:

  • Expensive acute care beds will open more quickly, which will make it possible for caregivers to meet the needs of waiting patients more quickly.
  • The transition is eased for the patient if they get to their post-acute facility earlier in the day because typically full staff is on-duty to get them settled and make them comfortable.
  • The patient and family experience will be improved by minimizing wait times—that unfortunately are common—before the patient moves to the next phase of their care journey.
  • Medical transport—which can be a bottleneck—can also be integrated to further enhance patient flow.
  • For health systems with a complete continuum of care, there is the potential to keep the patient in-network.

So how would this work you might ask? 

  • When orders are written for a patient in an acute care setting to move to a post-acute facility, the patient and their family are presented with a list of facilities based on a radius they choose.  Typically they can then select three to five facilities.  Hospital case managers or social workers then either enter the request electronically or call to see who has an available bed.  If there aren’t any openings at the patient/family’s top choices, or they refuse the facility that has a bed, the case manager must go back to the drawing board and find additional options.
  • Once the patient/family approves the placement, the case manager places the patient in the right bed at the requested facility via TeleTracking’s Capacity Management Suite.  A mini-command center provides staff with the visibility that makes the request possible, showing metrics like discharge milestones, confirmed discharges, bed status, patient attributes, etc.
  • Once the patient/family and case worker find the right facility, their insurance then needs to authorize the care.  Once that is complete, they’re ready to move—where the right bed, along with the care team is ready for their arrival.

Here are a few of the differences Skilled Nursing Facilities [SNF] have from the typical acute-care processes:

  • Supervisors are often the only ones with the authority to mark a bed clean.  However, this part of the process doesn’t typically delay the patient because it takes hours for patients to get their insurance authorization, gather their belongings, and travel to the SNF.  It is a common practice to place a patient in a dirty bed since the expectation is that the bed will be clean by the time the patient arrives.
  • Leaves of Absence (LOAs) are another difference.  SNFs have residents that may move back and forth between care settings—but may want to hold their room. In these cases, SNF staff block the room in the system (TeleTracking). In the case where the resident does decide to give up the room, EVS can’t start cleaning the room until the resident’s things are removed.
  • The insurance authorization step—which typically takes two to four hours—causes a delay in which the acute care facility can’t send the patient until the authorization is secured.  This means the bed is blocked basically, with no guarantee that the placement will actually happen.
  • Given the fact that care managers may reserve a bed at more than one facility as a backup, the supervisor may be holding a bed for patient who may not present, and turn away another patient in the meantime.  The data generated on the number of patients turned away in these circumstances could be used as a tool to reduce this practice.

And that’s what it really comes down to—the power of data.  Metrics that can be used to track progress and drive change.

Over the past 25 years, there have been amazing leaps forward in improving the patient experience by improving patient flow.  It will be just as exciting to see these processes integrate into other aspects of the care continuum—leading to a truly seamless patient experience.

Categories: Patient Flow