The Covid-19 epidemic has led to an unprecedented shift in patient volumes across settings. Some hospitals have had to operate at well over 100% capacity, while others have experienced rapid declines due to patients avoiding care. But hospitals aren't the only care settings seeing this type of shift: Many post-acute providers have realized similar decreases in volumes due to outbreaks in their facilities and cancelled elective procedures.
The missing piece of your Covid-19 capacity strategy: Post-acute care
Health systems that own post-acute facilities are in a unique position to leverage those assets to rebalance capacity across the system. Below, we explain how two health systems did just that with their inpatient rehabilitation facilities (IRF).
Early data on Covid-19 patient needs suggest that many require intensive therapy after discharge from a hospital—often in a skilled nursing facility (SNF). However, because so many SNFs have experienced significant outbreaks in their facilities, most are unable to accept new patients until after they have tested negative for Covid-19 multiple times.
This policy protects current SNF patients and staff from exposure to the virus, but inadvertently results in patients getting held up at the hospital. This not only strains hospital capacity, but also prevents patients from accessing much-needed therapy services.
To solve this problem, Ochsner Health, an 11-hospital system based in New Orleans converted one floor of its inpatient rehabilitation facility (IRF) into a Covid-19 SNF, which was in use from mid-March through mid-May. Ochsner took three steps to repurpose the space in just five days:
In just 10 days, the unit was operating at full capacity, allowing Ochsner to clear out an entire med-surg unit at the hospital. By May 13, they were able to convert the unit back to rehabilitation services full-time.
For more information on how Ochsner converted its IRF, read our in-depth case study here.
Even outside of patients requiring SNF care, many hospitals have found that their inpatient surge predictions are so high that their med-surg capacity still isn't big enough. While some systems have turned to non-health care facilities or outpatient clinics to expand capacity in these scenarios, low-volume post-acute facilities already have the space and structure to manage patients who would otherwise be in the hospital.
WellSpan Health's predictive models projected that their flagship hospital, WellSpan York Hospital, would need an additional 120 inpatient beds at the peak of the surge. To create this additional capacity, they converted their combined IRF and surgery center, the WellSpan Surgery and Rehabilitation Hospital (WSRH) into additional med-surg beds. A multidisciplinary team from across the health system convened twice a day for two weeks to plan the transition. The transition followed four steps:
By preparing WSRH to treat med-surg patients, WellSpan was preparing for the worst. Luckily, Pennsylvania was able to flatten its curve with social distancing measures. Because of this, WSRH has not yet had to admit any overflow med-surg patients. However, the hospital remains prepared if the need arises. More importantly, the two-week process forced them to get creative with the way they provided care and interacted with the health system. They plan to keep many of those measures, including the telehealth system, as permanent features at WSRH.
For more information on this process and WellSpan's lessons learned, read our in-depth case study here.
Over the coming weeks, the Post-Acute Care Collaborative will be publishing more research answering key questions for hospitals about Covid-19 discharge strategy, including how hospitals can discharge more patients to home health, bypassing the need for additional facility-based care.
To read more of our current work on the topic, review:
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