Pulse
Hotel Management
An orthopedic group is experimenting with having surgery patients recover in a hotel.
By Suzy Frisch
Orthopedic surgeon Marc Swiontkowski, M.D., kept hearing the same complaint from his patients at TRIA Orthopaedic Center: that it was difficult to recover from surgery in the hospital with all of the hallway noise, overhead pages, beeping machines, and interruptions from care providers. So when a high-end hotel started going up near TRIA’s outpatient surgery center in Bloomington, he got an idea: Why not let some patients have their procedures done at the outpatient surgery center, rather than the hospital, and recover at the new Hilton?
“It was a little out of the box, and some people thought it was crazy,” recalls Swiontkowski, CEO of TRIA. “But when you ask most people if they would rather recover in a hospital or recover in a very nice hotel, it’s a no-brainer for them. Couple that with the fact that it’s costing the health care system less, and it’s doubly a no-brainer.”
Safety First
Although the benefits were obvious to Swiontkowski, he knew others would have to be convinced. TRIA’s surgeons and its parent organization, Park Nicollet Health Services, wouldn’t put patients at unnecessary risk, and insurers certainly wouldn’t consider paying for them to recover in an environment that was not safe.
A team from TRIA and Park Nicollet began researching the feasibility of the idea. They found that the Sioux Falls Surgical Center in South Dakota had a similar program that allowed patients to recover at home, at the center, or at a connected hotel, depending on their condition after surgery. However, nothing like this had been tried in Minnesota.
They thought the concept had promise. “People in a hospital are very sick, and a lot of our patients are not,” says Mary Haugen, R.N., TRIA’s nursing director, who became involved after the team visited the Sioux Falls facility. “They are active and healthy, and maybe they don’t need to be in an acute hospital setting.”
Just the Facts
- 85 hospitals in Minnesota are a part of larger health systems.
- The system with the most hospitals is Mayo Clinic, with 11 hospitals and 2,659 licensed beds.
- Minnesota’s oldest hospital is St. Joseph’s Hospital in St. Paul; its newest hospitals are Maple Grove Hospital and PrairieCare, both in Maple Grove.
Source: Minnesota Hospital Association
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Next, TRIA’s leaders asked its surgeons to develop a list of procedures that would be appropriate for a hotel recovery. The initial list included partial knee replacements, multiple ligament reconstructions, and hamstring and quadriceps repairs. At the same time, TRIA’s anesthesiologists created a screening tool to identify patients who would be candidates for a hotel stay.
To be considered for a hotel recovery, patients could not have comorbidities such as diabetes or significant cardiac disease, a body mass index over 42, obstructive sleep apnea, or a history of difficult pain management.
TRIA officials then contacted Hilton management to gauge their interest and started a review process to ensure that the hotel could meet the standards for room cleaning and infection control. (Haugen found that the hotel’s cleaning requirements are as stringent as those at a hospital.) The rooms also had to be ADA compliant, meet TRIA’s requirements for grab bars in the bathrooms, and have recliners and other equipment in the rooms to help postsurgical patients rest and recover. The hotel passed with flying colors.
The Hilton Experience
After developing care plans that spelled out what needed to be done for a patient before, during, and after surgery, TRIA was prepared to test its Hilton recovery program. On November 18, 2008, surgeons performed a partial knee replacement at the outpatient surgery center. After an initial postsurgical recovery period, the patient was taken across the street to the Hilton for the night. The pilot cases went smoothly (the bills for those first Hilton stays were paid by TRIA).
Since then, the process has worked something like this: In most cases, patients are driven by a family member or caregiver from TRIA to the hotel. The patient checks into a room with one adjoining it for a nurse, who provides care and monitoring. (TRIA typically uses the same sets of rooms, but the Hilton does rent them to other guests when TRIA patients aren’t staying there. The Hilton also brings in recliners when rooms are being used by surgery guests.) Throughout the night, the nurse helps with pain management, dressing changes, or trips to the bathroom. The nurse also might show caregivers how to continue caring for the patient at home. Each nurse is assigned to no more than three patients at a time, Haugen says.
If there are any questions or concerns, the nurse can contact the patient’s surgeon by cell phone or pager. The nurse also is equipped with an automated external defibrillator to handle emergencies. So far, there have been no such problems.
Representatives from TRIA meet with patients before they are discharged to ask about their experience, answer questions, address concerns, and make sure they understand their care plan. Two weeks later, TRIA follows up with a written survey.
Thus far, the responses have been overwhelmingly positive. One hundred percent of patients who have taken the survey say they would use the program again.
Haugen says they comment that they like sleeping in a comfortable hotel bed with high-quality pillows instead of a hospital bed and having access to a flat-screen television, a microwave, and a mini-refrigerator. And they prefer ordering complementary room service from the Hilton’s custom TRIA menu with its healthful and fresh choices over hospital food.
Since 2008, TRIA has made other procedures eligible for the Hilton program, including the total replacement of knees, shoulders, elbows, and ankles, as well as complex hardware exchange procedures. Most involve a one-night stay. Total knee replacements typically require a two-night stay, along with physical and occupational therapy two times a day. Instead of having those patients travel back to TRIA for therapy, therapists come to the Hilton to work with them. Any needed labs and or blood draws can be completed at the Hilton and couriered to TRIA. Surgeons also visit the hotel to check on patients.
After about 100 procedures involving hotel recoveries, TRIA successfully negotiated with four insurance companies to cover Hilton stays as they would a hospital stay. The payers focused on the program’s protocols for safety, infection control, and pain management, as well as outcomes and patient satisfaction data, and found much to their liking, Swiontkowski says. They were especially pleased with the cost, which is 20 to 45 percent less than a hospital stay, depending on the procedure and the length of stay. That’s a benefit for the payers, not TRIA, he adds.
Since the program began, the number of surgeons referring patients to it has increased from two to 18; altogether, 220 patients have participated. “Not one person has been admitted to the hospital,” Swiontkowski says. “That convinces people.”
A Trend in Health Care?
TRIA’s Hilton program, which is unique in Minnesota, reflects a shift in the market toward treating patients in stand-alone emergency rooms, surgery centers, and retail-based health centers instead of hospitals and clinics. Even so, outpatient surgery centers haven’t had much impact on patient volumes at Minnesota hospitals, notes Jan Hennings, communications director for the Minnesota Hospital Association.
She believes programs such as TRIA’s are something we will see more of in the future. “As long as they are properly accredited and they are following all the pertinent regulations and safety protocols, they should be able to compete in the marketplace,” Hennings says. “Health care providers are seeing that they can provide these services in a more cost-effective manner in free-standing surgery centers, and health plans like them as well.”
Steven Connelly, M.D., chief medical officer at Park Nicollet, says he isn’t concerned about Park Nicollet’s Methodist Hospital, where TRIA patients often had their procedures done, losing patients to such programs. “It’s an innovative program that looks at stratifying patients according to how healthy they are and attempting to be more cost-effective with the care that is rendered,” he says. “If this is successful, it allows us to offer the same procedure in a different setting, which then begins to bend the cost curve of medicine.”
Based on patient outcomes and satisfaction, Swiontkowski believes it won’t be long before others adopt the idea. But for now, he’s happy that TRIA has found a new way to help patients recover successfully from surgery in a safe, less expensive, and more restful environment. “The patient satisfaction data is overwhelming,” he says. “You don’t see numbers like that from hospital stays.”
Minnesota’s Ghost Hospitals
The Minnesota Hospital Association began tracking hospital closures in the state in 1987. Since then, more than 30 have shut their doors. Here’s a list of the ones that are no longer operating by the year they closed.
1987
- Community Memorial Hospital, Clarkfield, 13 beds
- Mounds Park Hospital, St. Paul, 220 beds
- Samaritan Hospital, St. Paul, 150 beds
- St. John’s Eastside, St. Paul, 354 beds
- St. John’s Hospital, Browerville, 32 beds
1989
- Caledonia Health Care Center, Caledonia, 18 beds
- Gaylord Community Hospital, Gaylord, 32 beds
- St. Mary’s Hospital, Winsted, 25 beds
1991
- Fairview Milaca Hospital, Milaca, 41 beds
- Greenbush Community Hospital, Greenbush, 27 beds
- Heron Lake Municipal Hospital, Heron Lake, 16 beds
- Metropolitan-Mt. Sinai Medical Center, Minneapolis, 736 beds
- Mountain Lake Community Hospital, Mountain Lake, 24 beds
- Parkers Prairie District Hospital, Parkers Prairie, 21 beds
- Trimont Community Hospital, Trimont, 24 beds
1992
- Wells Hospital, Wells, 28 beds
1993
- Pelican Valley Health Center, Pelican Rapids, 13 beds
- Comfrey Hospital, Comfrey, 8 beds
- Eveleth Health Services Park Hospital, Eveleth, 26 beds
1994
- HealthEast Divine Redeemer Hospital, South St. Paul, 130 beds
- Lakefield Municipal Hospital, Lakefield, 10 beds
1995
- Karlstad Health Facilities, Karlstad, 19 beds
1996
- Community Memorial Hospital, Spring Valley, 24 beds
1997
- HealthEast Midway Hospital, St. Paul, 246 beds
1998
- Chisago Health Services, Chisago City, 49 beds District Memorial Hospital, Forest Lake, 49 beds Rush City Hospital, Rush City, 29 beds
1999
- Harmony Community Hospital, Harmony, 8 beds
2001
- Trinity Hospital, Farmington, 47 beds
- Tweeten Health Services, Spring Grove, 10 beds
2002
- Arnold Memorial Health Care Center, Adrian, 9 beds
2003
- Zumbrota Health Care, Zumbrota, 24 beds
2005
- Minnewaska Regional Health System, Starbuck, 19 beds
2007
- Divine Providence Health Center, Ivanhoe, 18 beds
Source: Minnesota Hospital Association