As an administrator in a skilled nursing facility, I see firsthand and recognize the hard work that clinicians and professional staff that work in this type of environment must endure. Often, I bare witness to these unsung heroes of healthcare, working long hours with strenuous workloads, while trying to provide the best possible care for the patients and residents in their facilities.
As we all recognize, in today’s environment, many of our clinicians and caregivers are being asked to do even more, facing additional challenges by caring for more medically complex patients who historically have been cared for in hospitals. Many of these patients have multiple chronic conditions and require more comprehensive care.
Unfortunately, the burden is only likely to increase, as patient to staffing ratios continue to rise, trending upwards of 20 patients per staff person. To put it mildly, resources in post-acute facilities are stretched thin and new talent is hard to find and retain. To put it more bluntly, we could see a worsening of the current staffing crisis in post-acute facilities if we don’t adopt solutions and workflows to help counter some of these trends.
In addition to having more medically complex patients, post-acute facilities are also facing increasing competition for patients as admission rates fall. These trends plus new CMS regulations that impose reimbursement penalties related to hospital readmissions, put pressure on us all to deliver better financial and health outcomes.
We have an opportunity to turn the tide on these challenges and help ease the burden on the clinical and administrative staff in our facilities, enabling better outcomes and more comprehensive care. Post-acute facilities should look for and adopt solutions that impact efficiency as well as improve patient care and safety. One such solution, we have adopted at Avanti Wellness and Rehab is continuous monitoring – a technology that is proving to be transformative in post-acute care.
Continuous monitoring technology was first developed for non-monitored patients in the
hospital settings and until recently was not practical for the post-acute world. That’s now changing as solutions are available that are easier to implement and install. Non-invasive, contact-free solutions are now available with sensors that slip beneath a patient’s bed mattress or under their chair cushion. These sensors monitor a patient’s heart and respiratory rates and detect patient movement, capturing multiple data points per second and sending this information to a central monitor, which then can push pertinent information to tablets and mobile devices.
The system allows clinicians and care staff to receive immediate alerts and take action if needed. In post-acute care, contact-free capabilities help facilities maintain a home-like setting that is as therapeutic as possible for residents and their families, while maintaining constant monitoring of patients’ vital signs and trends. No leads or cuffs are attached to the resident, making compliance easier, and they allow alerts to be muted in patient rooms.
Continuous monitoring solutions have already begun to make an impact in post-acute care facilities. Benefits range from fewer hospital readmissions due to earlier detection of patient deterioration, reduction in falls and pressure ulcers, and overall, improved patient safety. Another set of benefits accrues due to improved staff communication regarding resident health and status, empowering the staff to provide better, more efficient, and proactive care and giving them the satisfaction that they are making a measurable difference in the lives of the patients and residents that they care for. All of this can lead to higher career satisfaction, helping to solve some of the staffing challenges that post-acute administrators, like myself, face. Importantly, the residents themselves and their families are highly satisfied with the constant and consistent care they are receiving.
At Avanti, we have first hand experience with how contact-free continuous monitoring technology can help enhance the care we provide. Avanti is a skilled nursing facility that treats patients who come from hospital settings and have a wide variety of medical needs including rehab from orthopedic surgery, pneumonia, sepsis, stroke, amputations and surgical wounds. We are one of a few rehabilitation centers working closely with Advocate hospitals in a post-acute network program to reduce unnecessary hospital readmissions, as well as to rehab a patient in the quickest amount of time so that they return home safely.
As an ACO – SNF Affiliate, there is an opportunity to partake in the SNF 3-Day Rule Waiver, available under the Shared Savings Program and under the Track 1+ Model. This provides a new way of improving care and reducing costs while allowing ACO beneficiaries access to the appropriate level of care, potentially avoiding preventable days in the hospital. In an effort to provide the best care to our patients and to potentially prevent re-hospitalizations, the majority of beds at our facility now have contact-free, continuous monitoring.
Our immediate goals are to improve patient safety, monitor patient vitals, and optimize wound care management by reducing the incidence of pressure ulcers. We’ve already seen quality improvement with a reduction in falls, a reduction of falls with injury, and fewer hospital readmissions. The clinical team is notified when a patient is about to exit their bed and can quickly intervene. In fact, since installing continuous monitoring technology in December 2017, there has been a 31% reduction in fall rates.
Further, the rehospitalization rate for patients at our facility has gone down to 10%. This is markedly below the national rehospitalization rate of approximately 18% for post-acute providers. Our clinical staff is able to achieve and sustain these low rehospitalization rates because they are proactively intervening as soon as there is a change in the patient’s condition. Recently, our clinical staff was able to detect, intervene, and treat a pre-MI event in the facility. The staff was alerted to a high heart rate from the continuous monitoring system. They immediately assessed the patient, notified the physician, gave Metoprolol, and ordered an EKG, which was abnormal. The physician was able to adjust the parameters for Toprol and the patient stabilized. This was all done in-house and did not require a visit to the hospital; which was a big win for us.
These examples point to a future where we can deliver better patient care and safety in post-acute settings, and where we can support staff with real-time data to aid in early clinical intervention. When care teams can intervene quickly and prevent adverse events, everyone wins. As an industry, we aspire to provide the right solutions, so every clinician and caregiver has the opportunity to practice at the top of his or her license. As an administrator, I strive to give my post-acute teams the best tools possible so they in turn can provide the best care possible. We hope our care settings will have the best combination of staff and technology so we can heal as quickly as possible and receive the care we need to live our best lives.
Amanda Andrews is the administrator at Avanti Wellness and Rehabilitation Center in Illinois. She is a Certified Therapeutic Recreational Specialist and earned her certification from Rush Alzheimer’s Disease Center to help prepare leaders for the future in Dementia Care.