Lower census, higher Length of Stay
Many Xsolis clients, from NYC to Indiana to WA, have seen drops in overall patient volume. Though hospitals have seen a lower volume of patients overall, when there are more concentrated COVID-19 cases in an area, the patients they are admitting tend to be much sicker. According to the CDC, “The median length of hospitalization among survivors was 10 to 13 days.”[1]
According to the hospitals within the Xsolis client base, this trends seems to be borne out for acute inpatient. As this volume of high-intensity inpatients increases, hospitals are seeing a corresponding decrease in observation cases. At one NYC-based hospital, patient LOS is over 10 days on average to date; the hospital hasn’t seen an observation case in weeks. Below is a quick snapshot of Xsolis NYC-based client facilities observation rates over the past two months.
This trend is expected to continue in the near future as higher acuity patients remain the focal point of care.
Managing staff and space
Hospitals hardest hit are asking, “What if we don’t have enough beds?” This is an echoing concern across the industry. Hospitals have been quickly adding ICU beds, re-purposing office and administrative space and getting creative in adding capacity (remote testing sites and treatment tents are prime examples). As leadership looks to adapt, they should ensure case management leadership is brought to the table on planning and roll-out.
Another consistent question is “What if we don’t have enough staff?” With a high volume of patients, all clinical hands have been brought to bear in some locations. When planning to bring your clinical resources out of UR/CM and back to the bedside, keep a few things in mind: nurses that were most recently on the floor should be pulled first as their skills are freshest. At a Missouri-based regional medical center that Xsolis works with, all clinical staff has been required to attend skills training in case they are called back to the floor. Keep in mind, generally only nurses that are outside of the high-risk group should be re-assigned to accommodate the overflow.
Similarly, hospitals are also looking to make work safer and more flexible. Staff that has underlying conditions or are immunocompromised should continue their work from home, if possible. This requires healthcare workers to step outside of their comfort zone in some cases, but with manageable modifications, they can still be just as or more productive than in a hospital setting. At a Pittsburgh-based hospital, some remote staff were not able to access the EMR due to bandwidth issues, but fortunately the UR staff have been able to access clinical data through CORTEX, giving them the flexibility and safety to support continued operations. To create more flexibility in staffing, team members at a Tennessee-based organization are working in rotating shifts, taking every other week off to accommodate a decrease in volume.
Focus on discharge planning, SNF placement
As many commercial payers are waiving UR requirements, urgency around discharge planning has grown. Effective, timely and appropriate discharge is more crucial than ever, and staff are focused on timing and streamlining those discharges.
A blanket waiver was issued from CMS for skilled nursing facilities, eliminating the standard of three inpatient days required for a SNF stay. However, the patient still must demonstrate a need to go to a skilled nursing facility. Across the board, SNF transitioning and placement is proving tough because most SNFs are requiring patients to be quarantined for 14 days before they will accept them back. With a shortage of tests in many locations, this quarantining protocol means that hospitals bear the burden of keeping those patients safe and healthy during their quarantine period.
From the Editor: An Evolving Situation
As the COVID-19 pandemic continues, please refer to resources from CMS and the White House on proper response, protection and guidance on these and other issues. The Xsolis team is committed to serving you and our customer base throughout and beyond this time. Our healthcare client partners across the nation have been kind enough to share their stories with us as we created this article; we will highlight more of their stories and experiences in future issues.
Citations:
[1] https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html