Wayne County Hospital: Swing Bed Improvement in Risk-Adjusted Mobility


Wayne County Hospital (WCH), a Critical Access Hospital (CAH) in southcentral Kentucky, participated in a yearlong Swing Bed Quality Improvement project sponsored by the Kentucky State Office of Rural Health and the Flex Program. WCH staff needed to improve their Risk-Adjusted Mobility Performance scores for their swing bed patients, and WCH’s rehabilitation and nursing staff needed to work as a team in motivating their swing bed patients to achieve their mobility goals, heal, and return home.


Wayne County Hospital joined Stroudwater’s Swing Bed Quality Improvement Project which focused on the five metrics listed below. WCH developed an action plan for Measure 3: Risk-adjusted Performance Improvement in Mobility.

  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

WCH’s action plan included implementing care team huddles to discuss new swing bed patients admitted after the weekly interdisciplinary team (IDT) meeting, making additional PRN rehab staff available to accommodate increases in patient loads (allowing for BID treatments as appropriate), and providing additional education to nursing and rehab staff to ensure more accurate coding. As the project progressed, the WCH administration made a strong push to restructure the review of incoming referrals, focusing on timeliness in responding to referring facilities.


The collaboration between Wayne County Hospital and Stroudwater significantly improved communication, care coordination, and clinical outcomes for WCH’s swing bed patients. Alleghany identified reimbursement rates for their contracted payors.

Qualitative Results

  • Increased communication between rehabilitation staff, nursing, and the patient
  • Provided education for nursing and rehab staff to ensure coding is accurate and consistent
  • Established patient care huddles, resulting in better communication and more staff involvement
  • Increased family involvement

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.
    • Baseline value: Q3 2022 – 14%
    • Improvement shown in Q1 2023 at 16.7% and again for Q2 2023 at 24%


The more discussion there is about mobility, the more motivated swing-bed patients become. Working with Stroudwater, WCH staff made changes that put mobility front and center for staff, patients, and families during the healing process. The best practices that WCH staff employed to emphasize mobility to patients and increase collaboration among rehab and nursing staff helped them achieve their goals and improve outcomes for swing-bed patients, allowing them to return home sooner.