Once their acute needs have been met, they stay in the same bed, says Steve Taylor, chief financial officer of the Catholic Health Initiatives division that oversees 25-bed Oakes (N.D.) Community Hospital, a critical-access hospital. And they can be seen by the same nurses as the acute-care patient next door to them.
It also allows more patients to be treated locally.
Added expense and patient inconvenience are also avoided by eliminating the need to transfer these patients to a skilled-nursing facility.
In addition to flexibility, Taylor says, swing beds provide stability for both the hospital and for rural communities.
On a typical day, Taylor says, Oakes will have 10 to 12 inpatients with four or five receiving acute-care treatment and the rest receiving skilled-nursing care. This benefits the economic health of the hospital and, subsequently, for the rest of Oakespopulation of about 2,000as well.
It provides employment for the community, he says. Often, a hospital is the economic engine that runs the small town.
According to the Robert Wood Johnson Foundation, the swing-bed concept was developed in 1969 by a physician named Bruce Walter who was the Utah director of Medicare services. With the help of Tom Tierney, Medicares first director, a three-year, 25-hospital swing bed demonstration was launched called the Utah Cost Improvement Project in 1973. Despite some initial misgivings from nurses and opposition from nursing homes, the project was deemed a success and expanded to several other states before going nationwide in 1980. The concept spread even further with a $6.5 million RWJF program that involved 26 rural hospitals in five states.
One result of the program, the foundation reported, was the breaking of the mold of typical diagnosis-centered, doctor-dominated care in favor of nursing-centered team care.
William Hejna, senior principal for the Noblis Center for Health Innovations facility planning practice in Chicago, says the swing-bed concept is particularly useful for isolated hospitals with few options for transferring patientssuch as nearby hospitals, rehabilitations facilities or nursing homesand that typically have low but often fluctuating patient censuses with maybe 10 patients one day and 35 the next if, say, a flu bug hits the town.
From a quality standpoint, its a fairly advantageous resource, Hejna says. From the hospitals point of view, economically, if they had to discharge these patients and send them to a skilled-nursing facility somewhere, their revenue stream would be cut off.
But in addition to the benefits for hospitals, the concept also helps patients, he says.
From a continuity-of-care standpoint, they are great for the patient, primarily for rehabilitation after hip replacement or knee replacement, Hejna says. But patients need to spend three days in acute care to qualify for a swing bed; they cant just come in off the street or from their doctors office.
In terms of construction, Hejna and Taylor say that a swing-bed room requires the same physical characteristics whether its being used for skilled nursing or acute care. At Alegent Health Mercy Hospital in Corning, Iowa, for example, all of its 22 beds are designated as swing beds and are available for either acute or skilled-nursing care.
While physical requirements are basically the same, the Joint Commission has standards that specifically apply to swing-bed facilities.
Swing-bed requirements we focus on relate to resident rights and provision of care, says Laura Smith, an associate project director with the Joint Commissions Division of Standards and Survey Methods. Under patient rights, she says, the Joint Commission looks for an environment that creates dignity and a positive self-image, and this includes the right to privacy, to security, to receive visitors and to be free of restraints. Under provision of care, she says the commission looks for time frames relating to a plan of care and assurance that patients receive adequate notice before discharge or transfer.