Providing free beds can affect outcomes
Providing free beds can affect outcomes
The Inn at St. Thomas impacts LOS, cost issues
If patients undergoing cardiac surgery at St. Thomas Hospital in Nashville, TN, seem more relaxed and better prepared than others, it may have to do with where they spent the night. Patients scheduled for cardiovascular procedures the next morning can spend the night, free of charge, at The Inn at St. Thomas and receive nursing care at the same time. The result for the hospital is lowered costs and decreased lengths of stay. Clinical outcomes are sometimes improved, as well, because of generally happier patients. Most insurance companies look favorably upon the system.
St. Thomas is a tertiary referral center, and many cardiac patients travel sizeable distances to get there. Ivy Price, the manager of The Inn, explains how the concept evolved. "In years past, a courtesy program lodged next-morning cardiac patients in the hospital. But valuable inpatient beds and unnecessary staff were taken up by that system. Moving patients out of the facility and placing them at The Inn lowers costs, and at the same time, decreases length of stay because they are not admitted until the next day."
Cost Management in Cardiac Care asked Cathy Osten, RN, St. Thomas’ cardiac case manager, what she thinks of the system. "The facility has, without a doubt, improved patient satisfaction," Osten says. "Clinical outcomes are difficult to measure, but improved outcomes have been shown to be related to peace of mind.
"The program is unique. Some hospitals have a hotel unit where patients and families can stay the night before a procedure, but I don’t know of any other program that has nurses and preadmission testing attached. Patients staying at The Inn are actually assisted in their pre-op education and scrubs, she adds."
Before The Inn was available, patients coming from the surrounding area could do one of two things: They could spend the night in a pricey hotel in Nashville and come for surgery at 6 a.m., or they could get up in the middle of the night and drive long distances to the hospital. "Stress like that doesn’t put patients in the best frame of mind for open-heart surgery," says Osten. "Pre-op patients are often elderly and have elderly family members with them. They should be well-rested for their procedures."
St. Thomas is a Catholic institution and a member of the Daughters of Charity National Health System. "Because of its religious affiliation," says Osten, "St. Thomas looks at issues like patient satisfaction and convenience seriously."
Some insurance companies uncooperative
Under some circumstances, an insurance company won’t approve a request for open-heart surgery quickly enough, and patients have to forego a stay at The Inn. They go home, wait for the approval, and then come back.
"If a patient has an outpatient cath one day, spends the night at The Inn, and has surgery the next morning," says Osten, "a stay at The Inn is in the best interest of the patient. But if the insurance company needs 72 hours or more to process an application, that’s a tactical problem.
"Inefficiencies like longer lengths of stay and greater costs are without medical grounds when it comes to these pre-op patients. A patient with three-vessel heart disease may still have been functioning normally for weeks. There’s no reason for admission to the hospital until the procedure."
Patients at The Inn stay with their families in a nonclinical setting but receive preoperative preparation and preadmission assessment, including clinical studies, histories, and physical examinations. In addition, any lab work, X-rays, or EKGs that remain to be done can be performed there. Patients rely on themselves to take medication, but nurses offer support and counseling. They’re available for questions such as, "Should I take a laxative?" and "Do I still have to take this pill?"
The nurse can review the upcoming surgical procedure with the patient and the family and provide them with written material and videotapes. St. Thomas offers an open-heart class every evening. The nurse can assist in getting the patient to that.
No charge for nurses’ services
Patients are not billed for the nurses’ services. The clock doesn’t start running for care until admission the next morning. The services provided by the nurses at The Inn are a part of the infrastructure of the hospital, in the same way as public services, such as community teaching or blood pressure screens. Lab work, however, is done in the same way as any outpatient procedure and is reimbursable.
St. Thomas puts other categories of patients in The Inn as well. Some pay a nominal daily charge; some don’t.
If a patient undergoes an outpatient cardiovascular procedure, such as a coronary arteriogram, surgery may be warranted in a day or so but not on an emergency basis. Such patients are healthy and could go home and come back in a few days for their surgery. Instead, they can avoid stressful travel and spend that interim period in The Inn, comfortably surrounded by family. "That improves their anxiety levels," says Osten.
In addition, The Inn is used for discharging patients with special needs. "For example, if a truck driver or someone visiting the area has a heart attack and lands here," says Osten, "we often discharge them to The Inn. They otherwise would have to go home even after an evening discharge. We pay for their stay in that case. If it’s a matter of choice on their part for example, if they could get home safely early in the day they pay a nominal fee."
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