An initiative to add beds in strategic locations throughout Vanderbilt University Medical Center (VUMC), decrease patients’ length of stay and focus on morning discharges is paying off with improved patient access to services, hospital leaders say.
“The Vanderbilt University Adult Hospital leadership team continues to pursue creative, intelligent options to meet the increasing demand for the services we deliver,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and CEO of the Vanderbilt Health System. “We’ve focused attention on reducing length of stay as a way to increase the number of patients we can serve, and we’ve also added patient flow nurses in units to guide efforts in discharging patients who are ready to be released in the mornings rather than discharging them later in the day.”
More than 50 new patient beds are being added over the next 10 months, including a mix of inpatient beds and observation beds. Observation beds are those designated for less acutely ill patients who are provided additional diagnostic testing and treatment by clinical staff while a decision is made on whether to discharge or admit them.
Construction on these projects is expected to be complete by early 2017.
“We’ve been able to increase transfers to available beds by more than 100 a month, purely based on improvements in length of stay and by discharging patients earlier in the day,” said Stephan Russ, M.D., associate chief of staff at Vanderbilt University Hospital (VUH). “We are able to bring in more patients that need Vanderbilt services. This is a success.”
A 15-bed observation bed unit, located on the first floor of The Vanderbilt Clinic (TVC), was opened in February, and 20 observation beds will be added to this unit by December.
In August, 17 observation beds will be opened in VUH 7 South to serve cardiac patients, and in October five beds will be added to the Critical Care Tower.
In the final phase of clinical bed expansion, nine inpatient beds will be used for medicine patients in the A-Wing of Medical Center North.
Knowing that only adding beds would not eliminate all issues related to patient access, VUH leaders also examined how patients’ length of stay in the hospital, as well as the discharge process, was impacting the availability of beds.
Patient flow nurses initiate the discharging of patients either following morning rounds with medical staff or based on “anticipate discharge” orders that are entered by physicians the afternoon before. Getting those patients back home opens up beds for patients who are admitted later in the day, said Robin Steaban, MSN, R.N., Chief Nursing Officer for Vanderbilt University Hospital and Clinics.
“We’re trying to avoid unnecessary length of stay, but we’ll never discharge someone before they’re medically ready,” said Steaban. “The patient flow nurses are becoming experts at working with patients who are heading home, so they provide precise care. And, they’re also becoming real experts at managing systems problems that prevent patients from leaving efficiently. An example of that might be not having an available wheelchair, or required paperwork that hasn’t been completed, to allow a patient to go to an extended care facility.
“We’ve concentrated this expertise in a few specially equipped nurses, and it is making a difference for patients, physicians and staff,” Steaban said.
VUMC tracks the number of patients who are discharged before 11 a.m. each day, as well as the number of patients who go home within two hours of getting a discharge order, and since adding patient flow nurses to units, both of these metrics are moving solidly in the right direction, Steaban said.
