Inpatient Hospice: Better Data, Better Management

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By Coleen Schmidt, COO 
Horizon Home Care & Hospice Inc.
Smiling hospice caregiver with patient

Managing a hospice inpatient unit can be an exercise in frustration, even if the goal is to break even. But a focus on standardization and a strong data component can simplify this job considerably.

At Horizon Home Care & Hospice in Milwaukee, Wisconsin, data comes from a 30-minute daily dive into Hospice Advisor™ from Change Healthcare to see the number of patients on the unit, their level of acuity, planned staffing levels and the number of patients in the queue.

Our 14-bed unit currently has an average daily census of 10, which works well with our typical patient mix. Sustaining that level requires leadership and staff to understand that break-even is only possible with the right staff levels and acuity mix. For us, that means 85% general inpatients (GIP) and 15% routine patients.

As COO, being able to quickly see the acuity levels of patients on the unit and soon-to-be admitted helps me understand the challenges leadership and staff are managing each day. The hospice director and I can clearly communicate about staffing simply by looking at current and near-future patient acuity levels.

Setting standards

With bed management and staffing under control, we turned to the next factor in a well-run inpatient unit: standardization. Our typical patient stay is four days, and floating pool staff are called in when admissions surge, so workflow standards are essential.

This is a cultural issue and should be addressed in relation to patient safety. That is, if every nurse believes she has the “best” way of doing things, we are going to endanger patients.

Documentation, plan of care creation, and clinical care must be as standardized as possible if we’re to care for patients in the best, most-efficient way. For documentation, that means having an in-room device or a computer on wheels. In our experience, documenting in the moment is far superior to documenting in the hall or at the nursing station.

To standardize our care plan creation, we assigned this task to the third shift. Admissions typically happen during the day, and third shift is responsible for all plan of care creation in Hospice Advisor, which I then use to track the status of all care deadlines.

Data is king

Data is key to improving a number of other areas of the inpatient hospice, as well. For example, documenting in the system allows clinicians and administrators to quickly track which goals are being measured for which patients and how many were achieved during that shift. Often, that data is used in a shift-change discussion that recaps the patient’s primary caregiver, frequency of visits, patient’s preferred location of death, patient’s spiritual needs or concerns, any changes to care plan, progress toward goals and the plan for ongoing visits.

Similarly, I can review an entire shift by clinician or filter to look just at pain assessments or a particular goal. This is a fast way to get a sense of whether or not a patient still qualifies and is at the right level of care.

Finally, we’re educating clinicians on the importance of moving away from narrative text. Many nurses prefer it, but it’s an enormous cost—overtime because narration takes longer, followed by an administrator’s time to sift through the narrative. We’re also pushing nurses to document care-coordination efforts; currently this is often missing from the patient record, even when a nurse spoke to a physician about the patient during his/her shift. In both cases, it’s a matter of understanding how data-driven our industry has already become and how it can be used to improve care.

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