Swing Bed Quality Improvement Project

Challenge

Leadership and staff at Marshfield Medical Center – Park Falls (MMC-PF), a Critical Access Hospital (CAH) in western Wisconsin, wanted to improve the facility’s swing bed metrics. Swing bed patients needed to build greater mobility and reach self-care goals to heal and return home, yet there seemed to be a disconnect between rehabilitation staff, nursing, and the patient on knowing who was responsible for what. MMC-PF wanted nursing staff to be an integral part of the team helping swing bed patients improve their mobility and self-care goals. Like many CAHs, MMC-PF faced challenges with communication between departments; this situation was exacerbated by the strain of COVID-19, staff turnover, and a lack of resources. The hospital was looking for a partner to help leaders set new expectations, improve communication across departments, and educate nursing staff around these goals.

Process

MMC-PF joined Stroudwater’s Swing Bed Quality Improvement Project, which Stroudwater facilitates across 11 states, and developed action plans around two of the five key swing bed metrics:

  1. Return to Acute (unplanned)
  2. Return to Acute Post 30-Day Discharge
  3. Risk-adjusted Performance Improvement in Mobility
  4. Risk-adjusted Performance Improvement in Self-Care
  5. Discharge to Community

Stroudwater worked with MMC-PF to focus on Risk-adjusted Performance Improvement in Mobility and Self-Care, employing the following tools and resources:

  • Stroudwater’s Swing Bed Quality Assurance Performance Improvement tool
  • Training and education for the Swing Bed Quality Improvement Project
  • Facilitated peer-to-peer networking meetings
  • Action planning, data trending, and benchmarking

Results

The collaboration between MMC-PF and Stroudwater led to significant improvement in communication, care coordination, and clinical outcomes for MMC-PF’s swing bed patients.

Qualitative Results

  • Increased communication between rehabilitation staff, nursing, and the patient
  • Education for nursing staff on treating swing bed patients, letting patients do things for themselves instead of doing things for them (a difference between swing bed and acute care)
  • Utilization of a whiteboard to outline clear expectations for staff, patients, and patients’ families
  • Development of a plan for each nursing shift to work with patients on reaching self-care goals and mobility goals through exercises and walking

Quantitative Results

  • Risk-adjusted Performance Improvement in Mobility
    • Risk adjusting the mobility assessment produces an expected improvement score for mobility. Stroudwater compared the actual improvement score to the expected improvement score and returned the percentage of discharges that met or exceeded the expected improvement score.
      • Q4 2021 – 7 discharges – 42.9%, which is better than the national median of 27%
    • Risk-adjusted Performance Improvement in Self-Care
      • Risk adjusting the self-care assessment produces an expected improvement score for self-care. Stroudwater compared the actual improvement score to the expected improvement score and returned the percentage of discharges that met or exceeded the expected improvement score.
        • Q4 2021 – 7 discharges – 71.4%, which is better than the national median of 48%