In October 2016, UAB Hospital established a new Special Care Unit (SCU) designed to improve care for patients on a ventilator with a goal of weaning them off the machine sooner. In the first 12 months, ventilator wean rates exceeded the national average and hospital readmissions, along with ventilator length of stay, have dropped significantly with these types of patients.
The UAB Hospital SCU is the first unit of its kind to open in Alabama. Since opening, more than 125 patients have been transferred to the unit.
The hospital partnered with Special Care Providers of America which has been operating these care units for 27 years. "Unlike Long Term Acute Care Hospitals (LTACHs), our company does not build hospitals, nor do we rent beds and renovate wings in existing facilities," says Phillip Morris, RN BSN, Chief Clinical Officer for Special Care Providers of America and a UAB alumnus. "We partner with acute care hospitals and operate these specialized units within the host hospital. That allows the hospital to maintain control over quality and outcomes."
For acute care hospitals, management of these critically ill patients can pose challenges in the areas of throughput, increased length of stay, and readmissions. Their multiple co-morbidities can make these patients prone to hospital-acquired conditions. With the growing importance of quality metrics, those risks can have a negative impact on a hospital's financials. The SCU can help both patients and the hospital's bottom line.
"UAB saw a need for consolidating a complex patient group into one unit instead of treating them in various units," Morris says. "Our SCU patients come from the trauma and burn unit, medical intensive care, neuro intensive care, and surgical intensive care. Prior to opening the SCU, each unit would be responsible for weaning their own patients."
Special Care Providers manages these units with a multidisciplinary approach. "Once embedded in a partner hospital, each of these patients is transferred from a unit within the hospital to the SCU allowing all consulting physicians to follow their care," Morris says. "We provide the necessary staff - acute care nursing personnel, respiratory therapists, physical therapists, speech therapists and occupational therapists - with low patient-to-clinician ratios that are not common to LTACHs. This concentrated multidisciplinary unit enables us to deliver better outcomes for the hospital."
"With UAB, we have been able to wean 81 percent of the very complex patients, which is phenomenal based on the national average of around 60 percent. We are decannulating - removing the tracheostomy completely - in about 64 percent of patients. That means we are decannulating a higher percent than the national average is for weaning them. We are keeping hospital-acquired infections to a minimum and are reducing readmissions to less than six percent. A lot of hospitals are looking at 30 to 60 percent."
In another effort to maximize patient care, Special Care Providers has employed Bluetooth technology to track dwell time with the patient, by discipline. "Each patient bed has a Bluetooth beacon that interfaces with each caregiver's special badge to record how many seconds a healthcare professional was with a patient," Morris says. "There is an interactive dashboard that illustrates how recently a patient has been seen. The next step in this research is measuring the impact of dwell time by discipline on patient outcomes. We have seen research on patient outcomes related to nurse shift times, ratios and nursing education, but we haven't found any research related to the amount of patient care by discipline and how that affects outcomes. We are working with UAB on this effort and look forward to presenting our findings."
According to Special Care Providers, this complex patient population is growing in the Medicare and commercial insurance markets, due to the aging U.S. population, an increasing prevalence of chronic illnesses, and advances in critical care medicine. "While we are ecstatic about the results we see at UAB Hospital, we also recognize the growing need throughout our country," Morris says. "We are prepared to support our acute hospitals in improving outcomes for this patient population."