A Swing bed program is a benefit to community members who have the opportunity to receive care close to home and can also be an important revenue opportunity.
The processes of pre-admission, admission, continued stay and discharge are of course vitally important to ensure that the hospital is meeting regulatory requirements. But, does it really matter if the patient, or their family, is not satisfied with the care they receive or the swing bed experience?
Ask yourself, would you be “Extremely Satisfied”, or “Extremely Dissatisfied” if you were a swing bed patient in your hospital? Here’s some thoughts on how to improve patient empowerment and the patient experience.
Number one; The Care Team: Care for a patient in swing bed doesn’t really seem any different to staff and provers than care the patient received when they were in acute care. As a result, the process may seem cumbersome or not necessary such as why swing bed patients need: a new medical record or a new assessment or a new history & physical or new orders or a multi-disciplinary plan of care that has measurable objectives or why a certified nursing assistant needs to attend the multi-disciplinary care conference or why the patient needs to be out of bed and dressed every day or why activities are important or…………………(fill in the blanks).
If staff and providers don’t have a good understanding of swing bed processes and why they are important to the patient’s recovery then, in all likelihood, the patient is not going to understand either.
And, one other consideration, when the patient is in swing bed it is usually NOT NECESSARY to have the same frequency of assessments and vital signs that are typically in place for an acute care patient. Let the patient sleep – undisturbed – and heal.
Carolyn’s Five Tips Plus One
- Identify swing bed as an important service line.
- Identify a Swing Bed Coordinator/Champion that is passionate about swing bed.
- Develop reliable processes (Same Way Every Time) with staff input — Think Lean!
- Educate and develop competencies for staff and providers.
- Provide feedback on patient satisfaction and patient outcomes to ALL staff and providers involved in the care of swing bed patients – Tell Stories!
- Celebrate and reward individuals or teams that are doing a great job.
Number Two; The Admission Process: The admission process can be daunting and overwhelming for patients given the amount of information the hospital is required to provide, including patient rights, patient responsibilities, choice of physicians, how to file a complaint, and financial obligations to name just a few.
The intent of the admission process is to help the patient and their support person understand the purpose of swing bed and the vital role they play in partnership with the care team in recovery. Unfortunately, this sometimes gets lost in the plethora of information provided.
Carolyn’s Five Tips
- Don’t start with paperwork.Talk to the patient about their goals and expectations for the swing bed stay, including discharge plans.
- Explain the importance of the patient’s role in their recovery and HOW the care team will involve them in planning their care.
- Explain WHY swing bed is different than acute care and any expectations such as getting out of bed and getting dressed each day and frequency of physician visits
- Ensure any written information is in large font size and graphically easy to read – NO COPIES OF COPIES OF COPIES OF COPIES.
- Go Slow to Go Fast — Although it’s sometimes easier for staff to go through all the required admission information at one time, break the admission process into smaller steps so as not to overwhelm the patient. Remember CMS requires the information must be in writing in a language or manner that the patient (or the patient’s support person) can understand.
Number Three; The Assessment: Just like the admission process, the assessment process can be overwhelming and confusing for patients. After all, they answered many of the same questions when they were admitted to acute care and are likely thinking, ” why do I need to do go through this again and answer the same questions?”
Explaining to the patient the reasons for a new assessment, which disciplines will be completing a new assessment, including activities, and the difference between the acute care and swing bed assessment is extremely important for patient satisfaction.
Carolyn’s Five Tips
- Explain to the patient which disciplines will be completing a new assessment and how the information will be used in developing a plan of care. Consider scripting a few simple phrases for staff to use when sharing the assessment process.
- Identify which discipline will assess which element of the comprehensive assessment – don’t duplicate if at all possible.
- Don’t just check the boxes — really listen to the patient. This will help patients to build a sense of control and empowerment and participate in their care.
- Use caution when assessing for Trauma-Informed Care. Make sure the individual who is completing this portion of the assessment is sensitive to any patient verbal or non-verbal cues that they do not want to discuss or provide information.
- Don’t forget the family or support person. Involving the family or support person in the assessment process, with the patient’s permission of course, can provide valuable insights and information to help ensure the assessment is comprehensive and is reflective of the patient’s needs and long-term goals.
Number Four; The Swing Bed Stay: The swing bed stay does not have the same goals as an acute hospital stay, and the patient is not acutely ill. The focus is providing the patient a skilled level of care, rehabilitation or nursing, so the patient can safely return home or to a lower level of care. To achieve this goal, it is important that everything possible be done to: show that swing bed is a different level of care; promote patient independence and self-care; and actively communicate and involve the patient in their ongoing plan of care.
Carolyn’s Five Tips Plus One
- Move the patient to a different room. And, if possible, decorate the room so it has a more home-like environment.
- Get the patient up and dressed every morning.
- Encourage the patient to do as much as possible for themselves.
- Provide therapy / meals / activities in a location outside the patient’s room and post a schedule in the patient’s room.
- Actively involve the patient in development of plan of care.
- Post the plan of care in patient’s room with measurable targets, expected length of stay and discharge plans.
Number Five; The Discharge Plan: The discharge process is usually not as overwhelming as the admission process, but there is still a fair amount of paperwork that must be provided to the patient. Again, it’s important that the patient understand what information they are being provided before they are asked to sign.
However, the most important part of the discharge process to ensure a safe discharge and that the patient or the next provider of care has the necessary resources and information.
The new swing bed regulations issued in October of 2018 require that the patient is involved in developing the Discharge Plan of Care (as it should be). This process doesn’t have to wait until the last minute – but should be discussed at each care planning meeting and any teaching needs or other resources identified and started sooner rather than later.
Carolyn’s Five Tips
- Start the discharge planning process early and involve the patient. Plan for the Day, Plan for the Stay, Plan for the Way.
- Provide discharge paperwork over the course of several days – not all at once – if possible.
- Provide accurate medication reconciliation information (medication reconciliation at discharge is now a requirement).
- Identify one person to gather all of the necessary information / documents required to be provided to the next provider of care.
- Ask the patient – HOW DID YOU DO? A brief patient satisfaction survey at the time of discharge can allow you to focus on areas for improvement.
For questions on the swing bed services within your community, please contact Carolyn St. Charles at Carolyn.firstname.lastname@example.org.