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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, January 10, 2012 Posted in: Inpatient Rehab

Every unit/facility has a specific number of beds, and to operate efficiently, you have to determine what the lowest denominator for those bed numbers can be with just a little play to allow appropriate gender/infection co-habitation allowances (non-private room management). Knowing that number also allows you to operationalize a staffing plan that is consistent and does not require floating unfamiliar staff onto the unit, or managing the difficult swings that occur when census varies significantly during the week. So I ask, what is your ideal bed capacity? Can you make that capacity more profitable is the next question?

Bed utilization is the foundation of profitability, if and when you know the number you need to remain full,and staff has the ability to work effectively on a turnover rate that meets the patients goals and improves bed capacity. I’m sure you’ve heard the saying, “no margin – no mission.” We all have. How can everyone work together to be certain the turnover rate is effective and efficient from both a patient quality standpoint and a business sense? From restaurants to  the airline industry, they capitalize on seat capacity to manage profitability. Bed utilization in healthcare rivals those analogies.  How do you smartly manage a specific capacity to enable constant workflow (reduce peak and valley chaos), and meet the expectations of the customer, which happens to be the patient, and all the stakeholders of your business?

You can, but it starts with a plan.  Know the patient’s specific barriers to discharge, set the exact targets to meet management of the care that can be provided at discharge and work tightly to that plan; discharging the patient as soon as those goals are met.  Rehab has notoriously shown discharge patterns at 7-day cycles, some suspect because we wait for team conference to act on individual patient readiness.  If this is you, you missed turnover opportunity immensely.  You can analyze this.  Download your admission and discharge dates over the past year and see how close you are to a number divisible by seven. What percentage of your patients are at the peak of the bell curve? Pitch out the return to acute care patients and re-run that number. Now what does it look like?

If your patient population is predominantly rehabilitates on a 7-day cycle, there’s room for improvement in your turnover, bed utilization plan.  I promise!

IRFs have a good system for monitoring functional independence in order to plan needed resources at discharge through functional impairment measurement.  Set the goal for each of the 18 areas and then work diligently toward meeting that level of assistance to enable safe discharge. Engage the caregivers as early as possible to help plan discharge follow through and make that plan happen as quickly as feasible for each individual.

If you do that, you have the ability to affect turnover and to maintain capacity at a rate that is feasible to a well-oiled plan of care focused specifically on meeting the intended needs of the patient so that any wasteful processes are squeezed tight.

Have you analyzed how well your staff creates the discharge plan/goal and how tightly they manage their plan of care to focus specifically on making that plan happen as expeditiously as possible?  Budgets will only get tighter, your best chance to reduce per patient costs and improve revenue is to manage bed utilization, turnover and tightly focused goal attainment.

You can do it! Start your plan today!


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