OASIS Alert

Published on Thu Jan 01, 2009 PDF

You are not your patients' only resource for care during off hours.

Your patients may need help in the middle of the night or on the weekend, but you don't have to rush to their bedsides.

You don't have to be at your patients' beck and call, says Shawn Severson, director of home health for St. Mary's/Clearwater Valley Hospital and Clinics in Cottonwood, Ida. "We stopped around-the-clock call nearly three years ago," she tells Eli.

Why: Agencies in rural areas or with a limited number of clinicians simply can't always have someone on call to answer patients' questions or respond to emergencies in the middle of the night. And, the Centers for Medicare & Medicaid Services demand only that you have clinicians available during business hours, Severson points out.

However, Severson and her team didn't simply stop offering on-call services to the patients in her area. St. Mary's/Clearwater followed this process to eliminate 24/7 call:

Physicians who aren't aware of your agency's capabilities and rules can't efficiently prepare their patients to return home.

Better: Make sure all the providers you work with are aware of your agency's stance on around-the-clock care. That way, they can make sure patients know how to get help outside of business hours and you aren't constantly reminding patients of the best way to receive nighttime care.

You don't want the worse-case scenario -- patients sitting at home in pain wasting their time trying to contact you when they should be turning to the hospital for help.

When you know you won't be available to help patients outside of regular business hours, you must make sure to catch potential problems before they blossom out of control, Severson advises.

"We have to be better at screening patients," she says. This includes closely examining patients with IVs and new wounds to ensure no problems will creep up overnight. Excellent screening can virtually eliminate your patients' need for care during the night.

Now that your agency no longer visits patients during the off hours, you must pay close attention to how often your patients visit the emergency room or are admitted to the hospital during the night, Severson notes.

"Each month, I check to see which days of the week our patients are admitted to the hospital or visit the ER," she says. That allows Severson to adjust the agency's amount of patient phone calls and visits in the hours before they close and after they open.

When the percentage of patients seeking help during the agency's off hours increases outside of normal fluctuation, she re-evaluates and adjusts her clinicians' routine to better meet patients' needs.

The Bottom Line: You can continue providing top-notch service without demanding that your clinicians work throughout the night, Severson asserts.