One of the most important lessons we have learned from the COVID-19 pandemic has been the critical importance of hospital bed capacity. Even with the opening of A-East, Salem Hospital continues to experience high census. We know from our length of stay work that a significant number of beds are occupied by patients who no longer have an acute need for hospitalization, but are lacking a safe discharge plan. No patient, staff or provider harm is acceptable to us and we know that patients who are in this situation no longer receive the benefits of hospitalization, only potential risks. Lack of a viable discharge plan also prevents other patients who are in need care from receiving it, as there is no bed available.
Many reasons for discharge delays
There are a number of reasons that patients are unable to discharge, but the lack of skilled nursing and long term care facility beds in our community are major contributors. Salem Health has worked extensively with our long term care partners, but they are struggling with many of the same challenges we are, including a shortage of staff, COVID isolations and financial difficulties. We are working to solve discharge challenges with a number of strategies.
Swing bed unit just one strategy
On Oct. 3, we opened B6 South as a swing bed unit for patients who are both ready for discharge and eligible for physical and occupational therapy to prepare them to return home. The unit is staffed by a nurse manager collaborating with our rehab manager from West Valley Hospital, and staffed with a combination of current staff, contract nurses and therapists, as well as support from the Salem Health float pool.
The swing bed unit is a temporary solution and even with it in place, we still have 22 to 25 patients each day who are ready to discharge but no viable discharge plan and are also not eligible for the swing bed unit. As the next step in our strategic work, we will open an Extended Care Unit (ECU) on B4 South.
ECU next step in addressing length of stay and census challenges
The ECU will allow for patients to be managed in a long term care discharge ready acuity setting with an appropriately aligned staffing model of a nurse manager and a mix of LPNs and CNAs. Initially, we will use contract employees. In addition to providing the right care at the right time in the right place, discharging these patients to the ECU will free up inpatient beds for those who need them.
Patients must be deemed medically stable for discharge and be identified as a >5 day discharge delay. They must also be experiencing a delayed discharge due to awaiting new placement at a long term care facility, hospice, or other community resources. Patients with complex medical and behavioral needs, COVID positive and those requiring airborne precautions will not be considered for ECU.
If you have questions, please contact Amie Wittenberg or Seunghyo Hong.