5
Common Hospital Problems
1.
Problem: Too many avoidable patient days.
Suggestions: When Ms. Ubbing a hospital consultant brought in an outside group to look at her hospital's inefficiencies, the group found that the number one opportunity for cost-cutting was in avoidable patient days. Patient days can add up quickly if providers aren't focused on moving patients to other facilities or their homes once appropriate. She says the hospital took several approaches to decrease patient days. They worked with nursing homes and extended care facilities to make sure patients could be transferred on weekends, to avoid keeping a patient in the hospital until Monday when they were ready to be moved on Saturday. The hospital also worked with physicians on length of stay and showed data that demonstrated how each physician stacked up compared to his or her pee
Ms. Ubbing says the
hospital's nurse leaders also introduced a concept called "full capacity
protocol." A hospital might be at "full capacity" for various
reasons: Perhaps so many patients are in isolation that second beds in
semi-private rooms are unavailable, or perhaps all the beds in the hospital are
actually full. Sometimes a patient waiting for discharge will occupy a bed when
there is no medical necessity — simply because it's easier to stay in the bed
than to go home. "What we do is we move the patient awaiting discharge to
a hall bed, and we put the sicker patient in the room to begin care
there," she says. "It's pretty amazing how soon that patient awaiting
discharge finds a way home."
2. Problem: Desire for
physician integration but very few employed physicians.
Suggestions: Ms. Ubbing's
hospital employs around 10 percent of its physicians, meaning the vast majority
of the facility's providers are independent. This echoes the traditional model
of physician practice, but it can mean hospitals struggle to integrate
physicians in order to take advantage of bundled payments. Ms. Ubbing says the
hospital may eventually move toward a greater percentage of employed
physicians, but for now, she uses co-management of hospital service lines to
involve her independent physicians in hospital operations. The hospital first
implemented co-management of the orthopedics service line and then moved to the
cardiovascular and thoracic service line.
When structuring the
co-management of the cardiovascular line, Ms. Ubbing says the hospital brought
together diagnostic and interventional cardiologists, thoracic surgeons and
radiologists — but also primary care physicians and nephrologists, two groups
that might seem out of place.
"If you step back and
think about it and look at 30-day readmissions, the care between
hospitalizations rests in those [primary care] offices, not in the
hospital," she says. "That's where primary care comes in, and that's
where nephrology comes in with vascular cases.”
She says the hospital placed
its trust in the independent physicians bsaying, "If you want to run how
clinical care is delivered in our hospital, come on down." Co-management
helps integrate physicians with the system, she says. "Unlike the
independent physician, who's doing his care for his patients the way he wants
to, he [now] has the opportunity to be part of an institute where the
incentives are for the whole group to perform at the highest level," she
says.
3. Problem: Unhealthy
community.
Suggestions: Under the healthcare
reform law, there are requirements as a non-profit hospital to perform an
annual healthcare needs assessment of its community. "One of our big
issues is around healthy lifestyles, and more specifically, obesity and the
disease stream it leads to," she says. Even as the insurance coverage
expands, Ms. Ubbing says community members still have to make the effort to
visit a physician and keep themselves healthy. In 2010, the hospital targeted
drug and opiate addiction in the community, and in 2011, the hospital plans to
target obesity. To fight drug addiction issues, the hospital required every
employed physician to register with the Ohio Automated Rx Reporting System, an
Ohio database that shows physicians a patient's prescription drug history. "There
are some pretty persuasive stories that show you don't know what you don't
know," Ms. Ubbing says. "One surgeon got a referral from a primary
care physician for surgery, and when [he looked up the patient in OARRS, he
found the patient didn't have one doctor — he had two. He was getting identical
prescriptions from both." The hospital also dedicated a newsletter to
issues around drug abuse and provided copies to anyone who wanted them.
In 2021, the hospital will
focus on obesity, a huge problem for many communities in the United States. The
community has raised money to sponsor local residents to ride their bicycles at
designated events where the courses run from 5-100 miles. Because the hospital is located in a farming
area, administration is trying to bring more local, fresh produce
to community members and
ensure nutritionally balanced meals in the hospital cafeteria. Ms. Ubbing has
been amazed by the willingness of community members to participate in these
initiatives: "People have come forward and said, 'I want to be part of
this,'" she says.
4. Problem: Poor
communication between providers.
Suggestions: Fairfield
Medical Center recently added a new role to its facility: clinical nurse
leader. "A clinical nurse leader is the first new role in nursing in 40
years, and this is a post-masters trained nurse who is on track like an
advanced practice nurse, except their training puts them in the hospital at the
bedside," Ms. Ubbing says. She says the hospital has assigned a clinical
nurse leader to micro-units of around 12 beds throughout the hospital, where
the CNL acts as a liaison between physicians and patients and mentors other
nurses. "We think this will reduce length of stay, eliminate some rework
and get better information flowing faster for decisions to be made," she
says. By installing a nurse leader to increase communication between providers,
she thinks patients will have a better healthcare experience with fewer
redundancies, and physicians will have a better understanding of what happens
to a patient when another provider takes over.
5. Problem: Physician and
nurse shortages.
Suggestions: Hospitals across the country are preparing themselves for predicted provider shortages. To offset physician and nurse shortages in southeastern Ohio, Fairfield Medical Center has partnered with Mount Carmel Health System in Columbus, Ohio, to bring a satellite college of nursing campus to the Fairfield facility. "[Mount Carmel] has a college of
nursing that rewards a BSN
degree, among others, and they ran out of bricks and mortar space. The cost of
that is expensive," Ms. Ubbing says. "They came to us because of the
vast majority of their students outside
Columbus come from here —
Fairfield County." Together, the hospitals installed a branch campus of
Mount Carmel's nursing school at FMC.
About two miles away from
FMC, Ohio University runs a branch campus — Ohio University Lancaster. Ms.
Ubbing says the nursing students from Mount Carmel do their first year of
classroom work at OU Lancaster and spend the next three years doing clinical
work at FMC. "There are up to 24 allowed in the class, and we're on our
third class this year," she says. "We have the benefit of developing
more nurses, and we have a three-year relationship with those nurses [by the
time they graduate]." The project benefits everyone: Mount Carmel doesn't
have to build more space, Fairfield County students avoid a 50-mile drive and
FMC has the opportunity to "grow their own" nurses.
The hospital has employed a
similar tactic to "grow" future physicians. The hospital currently
has a family practice residency program and is hoping to build an internal
residency program as well.
Jan Ricks Jennings, MHA,
LFACHE
Senior Consultant
Senior Management Services
724.733.0509 Office
412.913.0636 Cell
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