Rapid response and Select Specialty Hospital

[nrsang97, BSN, RN]

I have a few questions for those of you that work in a hospital where Select Specialty rents a unit from your facility.

Our rapid response team was informed that when they come back to our facility that they will be using our lab and radiology, etc as they did before. Now they are saying that SSH will be using our RRT as well.

How did that work in regards to getting a pt from their hospital transferred to your ICU for example post code? Was it a easy process or did it take awhile?

Just curious.

[MunoRN, RN]

My previous facility also rented out a unit to an LTACH company. My understanding was that there are very strict CMS rules about the degree of separation (not physical separation but functional separation) between Hospitals and LTACH's. Our Nurses could not work in the LTACH unit without a "distinctly separate" hiring and orientation process from the hospital's. We did provide some services to LTACH patients just as we did in Nursing homes in the area such as lab draws.

I would think your hospital would need to be very careful about adequately defining RR evaluations by their staff, and I'm not even sure it's really possible without leaving the RR Nurse and other staff exposed to problems. I would check with your malpractice insurance provider or union to make sure you are covered when seeing these patients. These are not patients of your hospital and could potentially be seen as patients the hospital staff cannot treat based on CMS separateness rules, which would mean you cannot have a Nurse-patient relationship with them while on the Hospital clock, which may mean you aren't covered. Plus, you're working under protocols that fall under Physicians of your hospital and are the hospital's protocols, so anything you do to patients of another facility might be considered out of scope since you may not be able to apply those protocols to the LTACH patients.

Anyway, according to CMS rules these patients must be considered transfers from another facility when they go from the LTACH unit to your ICU. They way I remember it, you cannot have separate policies for you in-hospital LTACH, and if all patients from another facility must go through the ER, then so must your LTACH patients. This was a while ago however and much of this may have changed, and I'm sure there are also many tricks for getting around these rules by now.

[BrandonLPN, LPN]

This is interesting. I never knew such arrangements existed.

I've always wondered why more of the bigger hospitals don't have their own subacute and/or LTAC units. It seems to me that if these companies can make a profit from the reimbursement for such patients, so could the hospital. Of course, I bet the reason most of these LTAC companies do show a profit is precisely because they are more cut-throat and profit-driven than the hospitals the or renting space from.

The way this is done, it almost seems like when a supermarket rents out some of their empty space to a bank or a McDonalds. Or like the system as a whole is just farming this level of care out to the cheapest bidder. I suppose that's the definition of "free market". Sometimes it's ugly.

As for the hospital's rapid response team responding to codes in the specialty hospital, well, it makes perfect sense on the surface. Nut I wonder what sort of legal horror would ensue in the case of a code that went wrong.

[Biffbradford]

As MunoRN states above, the major hospital I last worked at had an in-house LTACH and their codes went through the E.R. first.

[meljonumd]

At my hospital, our in-house LTACH is administratively separate from the rest of the hospital.

When a patient has a rapid response, they are considered transferred to the hospital service; and just like when the LTACH was housed in a separate building, if they are out past midnight, they are considered discharged.

If the patient needs ICU care, they are immediately transferred; paperwork catches up as needed.