Swing Bed Program
2021 was a year of innovation, born out of the desire to do as much good for as many people as possible, despite the challenging environment. Bellin Health Oconto’s hospital poured energy and effort into the development and expansion of their swing bed program. It was a pandemic project born out of statewide bed crunch, a desire to combat social isolation and a need for more complex care to be delivered in rural settings. Many skilled nursing facilities were closed to admissions or were at capacity, causing a bottle-neck back-up of inpatients who weren’t well enough to go home but needed another place to go. Even when there were skilled nursing facility beds available, the inability to see a family member caused patients such anxiety that they could not agree to the move out of acute care. This was the impetus of the project. Acute COVID-19 patients did not remain at Oconto, so it was a way to help the region and to help keep beds open in the larger hospitals for acute patients. Services were expanded and partnerships were built across the Bellin system to deliver the care these individuals needed.
Although licensed for 10 beds, six rooms were set up for inpatients and then several multi-purpose rooms in other areas of the hospital that could be used for inpatients. At first, the goal was set to fill six rooms, and then to fill 10 beds and keep the census relatively stable at those numbers.
The team began looking outside what was originally thought to be the definition of a swing bed patient in the past. It was important to determine what other things were feasible to do at a critical access hospital with limited resources. For example, a patient was admitted on peritoneal dialysis. The patient brought his home cycler; the hospital ordered supplies to be sent to the unit from our larger hospital in Green Bay that typically stocks those supplies. The patient was able to direct the peritoneal dialysis cares since he did his dialysis independently at home, but he was physically limited to do them himself. There were also referrals for patients who needed total parenteral nutrition. The pharmacy department created a process to manage patients with that need. Another area of growth was providing specialized wound vac care. The hospital does not historically keep wound vacs in house, so the referring hospital sent the wound vac with the patient, which is a great exercise in trust building and teamwork. The wound care team expanded services to assist in the specialty care needed by these patients. A small team of clinicians received training to ensure exceptional care could be provided even when wound specialists were not present. Patients came to us in a sicker and weaker state than ever before.
The swing bed team worked with each patient individually on goals that were meaningful and attainable to them. Patients who came in had resigned themselves to the fact that they would likely spend the rest of their days in a nursing facility; however, they achieved a goal they never believed possible and were able to be safely discharge to their homes. In past years, patients who came to swing beds were typically local. With nursing homes in the region full or closed, beds became scarce, and referrals continued to come in from all over. Several patients were admitted from Sturgeon Bay, Algoma, Appleton and regional locations who were unable to find a bed closer to home. The hospital fulfilled the mission to do the most good for as many as possible.
Although the peak of the pandemic has (hopefully) passed, the hospital continues to push the boundaries. The hope is to use the rehab beds for local folks needing rehabilitation and are willing to learn new skills or get new equipment to make that happen—for example, individuals needing tube feeding and those with mental health challenges with limited discharge options. The hospital team collaborated with specialty providers to provide more and more telemedicine visits. Some providers stopped by Oconto to see patients instead of having them sent to Marinette for a clinic visit. The project born out of necessity has brought a new sense of imagining what is possible and making it a reality through coordination across a health care system motivated to keep its patients at the center of its care.
This journey has taught many lessons. First and foremost, never underestimate the human spirit. The amazing hospital team, backed by solid processes, built hope for the patients, proving there was no such thing as an unattainable goal. Other lessons were more practical. Transportation is a big problem in rural areas. Many patients were unable to set up a ride with friends or family and do not have reliable transportation to get to follow-up appointments. Telemedicine has been so great for the patient to save the hardship of getting a friend or family member to drive to the appointment or simply just enduring a road trip when a patient is ill or having pain. The hospital developed a more robust wound care team to accommodate all the complex wounds and wound vacs, a much-needed specialty in this region. Last but not least, the huge increase in volumes caused the team to run low or even out of supplies that had always been plentiful (snacks, gauze, personal hygiene items, etc.). Orders that used to last a week were now lasting only one to two days, which meant someone had to go on a road trip to get those supplies until the periodic automatic replenishment levels could be increased. 2021 will be a year not easily forgotten. Amidst all the challenge, there was triumph.