BACKGROUND
Ellenville Regional Hospital participates in the CAH Swing Bed Outcomes Measures Project conducted by the University of Minnesota Rural Health Research Center in partnership with Stroudwater Associates. More than 230 CAHs in 21 states currently participate in the study. The web-based tool developed by Stroudwater is the first and only tool dedicated to measuring swing bed performance data.
ORGANIZATIONAL CHALLENGES & STROUDWATER’S APPROACH
Ellenville Regional Hospital is a 25-bed rural Critical Access Hospital (CAH) located in New York’s Southern Ulster County. The hospital, which sits 90 miles from New York City and Albany, offers a wide range of services including inpatient; physical, occupational and speech therapy; emergency care; cardiac rehabilitation; orthopedics; cardiology; and ambulatory surgery. The CAH has won numerous regional, state and federal awards for its quality programs. Total yearly patient revenue stands at about $41m. With Theresa Aversano, Director of Rehabilitation Services, taking the lead, the rehabilitation team at Ellenville created its swing bed program in 2006 to collect data, quantify outcomes, and return more patients to their homes rather than a nursing home. Because they recognize the importance of swing beds to their hospital and community, Ellenville’s management team elected to participate in the CAH Swing Bed Outcomes Measures Project conducted by the University of Minnesota Rural Health Research Center in partnership with Stroudwater Associates. Ellenville pooled its findings with the project led by researcher Ira Moscovice and joined a group of more than 230 CAHs nationwide measuring swing bed performance. The hospital has been using Stroudwater’s web application since April 2018.
RESULTS
Joining the national program allowed Ellenville to glean additional insights into swing bed performance by adding new measures, such as gauging a patient’s cognitive status at admission and discharge—especially important given how often these patients experience post-anesthesia syndrome and suffer from Alzheimer’s or dementia. Hospital leaders are now able to benchmark the hospital’s performance nationally and against 12 other CAHs in New York that participate in the statewide CAH performance improvement network convened and supported by the New York Office of Rural Health and its Rural and Community Hospital Flexibility (“Flex”) program. Ellenville finds Stroudwater’s webbased tool “relevant,” and meaningful, while noting that the collection process is still cumbersome as it requires manual data collection before it can be entered.
The staff has been highly invested in making the swing bed program a success and takes great pride in helping patients return to their homes in the community. Ellenville has seen a major improvement in self-care from admission to discharge, especially impressive given that 64% of the patients are 70-89 years old. The returned home rate for swing bed patients is 77% and rises to 91% if higher-acuity patients are removed from the data.
The hospital provides caregiver training, which includes teaching caregivers how to get their loved ones in and out of the car. Patients and caregivers are very appreciative of this “car-transfer” training, which is provided about a week before scheduled discharge. It also provides an extra layer of confidence that the patient is ready to return home.
Part of the goal of the swing bed program is to make a case with payors to keep patients in CAH beds rather than transferring to nursing homes where the care is reimbursed at a lower per diem rate. Ellenville is among many CAHs that are eager to prove that the additional per diem cost for the stay in a CAH swing bed (about 19 days at Ellenville) actually creates more economic value because patients are so frequently discharged to prior living conditions, rather than living in a nursing home indefinitely—and that readmission rates from CAH swing bed programs are much lower than their PPS post-acute counterparts. Ellenville also provides 24/7 access to emergency care on site, hospitalist service, radiological services, and rehabilitation services seven days a week, services that are not available at many nursing homes.
Ellenville staff attribute the success of the swing bed program to strong alignment across rehabilitation and nursing staff, as well as support, resources and interest from the hospital’s leadership. The rehabilitation and nursing staff continuously evaluate how to improve the program and are proud to be spearheading swing bed initiatives in New York state and nationwide.