save our unit!

[jctiabecerra]

we are needing budget cut suggestions for l&d, postpartum, and nursery:o

[magnum68]

we are needing budget cut suggestions for l&d, postpartum, and nursery:o

Obama Care

[AgentBeast, MSN, RN]

Many hospitals are getting rid of L&D completely due to the high cost of Liability Insurance.

[NPinWCH]

Ugh, I feel for you, my unit was closed in June and it was heart breaking for the staff and the community. The first thing that got cut was our unit secretary, then if nurses left they simply weren't replaced (which was not fun).

We cut back everything we could. We started doing charge audits on EVERY patient. We changed from hospital laundered uniforms to buying and laundering our own, we sourced less expensive replacements for our supplies, we made sure to capture every charge we could, we took more low census call, reassessed census more frequently, we stopped providing the hospital logo diaper bag, stopped automatically providing toiletries and put up a sign for patients to ask if they were needed, we made sure to turn lights off in empty rooms and hallways and did away with just about every little "extra" we offered.

The biggest problem with OB is that it is a nurse heavy specialty that isn't reimbursed well. When we were doing our audits we realized how little Medicaid reimbursed (and we had about a 75% Medicaid population). Reimbursement is basically a set price, so it doesn't matter if it's an uncomplicated SVD that went home in 24hrs or a patient who was induced, PIH with a postpartum hemorrhage that stayed 3 days.

We were shocked when we actually saw the numbers. It amounted to about $1200 for an SVD from admission to discharge. You figure the cost of having 1 RN on the unit 24 hrs and you're up to $600 and that doesn't include supplies, the cost of room/board or meds and IVs. If the patient is there 48 hours, which is not uncommon from admission to discharge, that $1200 only pays the RN's wage. Everything else costs the unit.

I wish I had an answer or was able to tell you this stuff worked, but I can't. Good luck to you and your unit.

[Elvish, BSN, DNP, RN, NP]

We've done similar things to the abovementioned post as well. I don't know if you change your linens on your babies' cribs every day, but if you do, you could stop doing that and just replace what is soiled. Ditto for mom's sheets, for that matter. Most people don't change their sheets daily at home, why do it in the hospital? Linens are a huge cost to our unit when we've run the numbers.

Some other things we've done:

after a discharge is gone/room is cleaned, make sure all the lights/TV in the room are off. This is a particular nitpick of mine.

Turn off unit lights that you can safely turn off at night. We dim the lights in the nursery as well - not completely off, but we turn probably 2/3 of them off. It seems to help the babies stay calmer too.

Everywhere is feeling the budget crunch, it seems. I'll post more stuff if I think of it and will be on the lookout for ideas to implement on my unit as well. :)

[tablefor9, RN]

great thread. Let's bump this regularly.

[ducknurse]

Our supply budget was a big focus. We stopped stocking "extra", really paired down OR and pt room supplies. Organization of those rooms really helped us see the extra's we had and labels helped focus stocking. Our organization as a whole has renegotiated a lot of our supply contracts for better rates.