Close relationship with SNFs benefits both parties
Hospital, nursing home staff collaborate
When Dartmouth-Hitchcock Medical Center in Lebanon, NH, undertook an initiative to improve the efficiency of nursing homes admissions, the task force looked at ways to improve communication and collaboration with local skilled nursing facilities (SNFs).
The hospital invited the medical directors of the local SNFs to a retreat attended by the care management staff and the hospital’s associate medical directors and asked them for a frank discussion of how the process could be improved.
"We gave them the opportunity to tell us their complaints and issues, and we came up with a healthy list. Now we’re working to smooth some of the issues out," says Sandy Dickau, RN, MS, vice president of patient and family resources.
They looked at barriers to admitting patients to the nursing home, problems with transition, and how the SNF staff and the hospital staff could collaborate to improve them.
For instance, the nursing home staff complained that they were being asked to take patients who were on very expensive medications that the nursing homes couldn’t afford to cover.
"We are a teaching center, and our doctors often use the latest and greatest drugs, but the nursing homes can’t afford that kind of medication costs," Dickau says.
The SNF team is working with the physician staff to help them understand the cost of the drugs and to make sure they consider potential alternatives.
The nursing home medical directors complained that they didn’t feel as though they were getting enough complete information on the referral and often asked the hospital to fax the entire chart, a job that is time-consuming for staff.
The hospital developed a uniform referral form with all the information the nursing homes agree is important. It cut down copying to a minimum.
The nursing home administrators cited problems in filling prescriptions and getting supplies if physicians changed patient orders the day of discharge.
"We’re a tertiary medical center and have access to everything 24 hours a day. We forget that the nursing homes have different contracts for pharmacy or medical supplies, and if we change the order at 1 p.m. and the patient gets there at 3 p.m., they don’t have a way to get the new medication or dressing," says Darlene Saler, RN, BSN, MBA, director of care management.
The hospital now makes every effort not to make changes in the plan of care at the last minute.
"We are in a unique position to hear feedback from the nursing homes and to find out where we need to focus our resources. It has been very helpful for our staff to understand and appreciate what the nursing homes go through," Saler says.
As a result of the meeting, the hospitals and nursing homes tackled ways to improve the handling of patients who have a bacterial infection and need to be isolated.
They convened a meeting of the hospital’s infectious disease staff, skilled nursing facility staff, and state health officials to look at the needs of the patients and how to work together to protect them.
"One of the wonderful outcomes is that we were able to influence the state in updating regulations. Through education, the nursing homes better understand the precautions and why they are handled the way they are," Dickau adds.
As a result of the increased communication, some nursing home officials have asked the hospital for guidance in whether they should specialize in caring for a particular type of patient in order to fill their beds.
"They’ve asked us what kind of patients we find most challenging to place. They are trying to find their niche," Saler says.
In return, the hospital works to provide resources to help the nursing homes care for their challenging patients.
For instance, one facility has expressed an interested in taking more pulmonary patients. The team has identified a pulmonary nurse who is agreeable to educating the nursing home staff on caring for pulmonary patients.
"We can use our own staff to do education and to provide resources the nursing homes don’t otherwise have access to," Dickau says.
When Dartmouth-Hitchcock Medical Center in Lebanon, NH, undertook an initiative to improve the efficiency of nursing homes admissions, the task force looked at ways to improve communication and collaboration with local skilled nursing facilities (SNFs).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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