Effectively Manage Inpatient throughput
How do you effectively manage inpatient throughput with :
- Limited skilled Nursing Facilities
- Limited long term care facilities
- No insurance coverage for a large segment of population
- Culture that prefers to be at hospital rather than discharged
We have ensured that patients and their family members are very clear on the discharge plan even before they are admitted. Once patients are no longer acute, we are able to charge a per diem. For those patients who just need additional support and time, we have worked in partnership with the city to provide supportive housing at a reasonable cost. This innovative model is receiving a lot of attention as there is a personal support worker that can be available 24/7 to assist with care needs.
1. Well trained nurses are always a premium. What we did was to look at what nurses are required to do and see if the tasks can be done by non-nurses such as nursing aids and volunteers. Investment in training and upskilling of these helps us stretch the capabilities of each nurse further.
2. Its a struggle to expand long term facilities. Probaly the greatest effect is intervention at primary care level.
Hello
We have implemented a high risk for discharge team, that includes a ALC Resource Nurse, Social Worker, Home Care Coordinator, and other care providers as required. The role of the team is to engage the patient and significant others in the discharge planning process. Due to the shortage of nursing home beds, we have partnered with Community Housing to establish a Seniors Supportive Housing Complex – 20 of the 80 units will be dedicated for discharge planning purposes. The cost per unit will be approximately $1200/month which will be covered by old age pension.
Seems like you have some challenges to overcome. Here are some thoughts for short term/longterm measures;
Short term:
-Expectation management towards patients before the enter your facilities.
-‘flag’ possible long-stayers as early as possible and separate them from short-stay patients.
-logistical management of critical resources to ensure efficient throughput in your facilities (daily discharge meetings, decision support systems, pull management etc.). Managing the bottleneck for the short term would require to streamline your business facilities as such that patients efficiently ‘flow’ through your facility and do not stay longer than medically necessary.
Mid/longterm:
-partnerships with long term facilities. Or when not available greenfield investment and expanding vertically?
-investing in education or importing skilled nurses from other countries.
This is a very challenging situation! I think it starts with changing the culture: education, education, education. You can utilize a rehab type facility and separate the patients that need acute care. A good strategy for maximization of your budget is the key, while you can start volunteer organizations.