Staff at GW Hospital have developed a policy they hope will help patients like the elderly and the mentally ill and make them a model for other area hospitals.
The hospital is focusing on educating legal guardians about their responsibilities and increasing accountability for court-appointed guardians. Patients who don’t have next-of-kin to make medical decisions can end up spending too much time in a hospital or not receiving adequate care. By making sure the guardians know their responsibilities and follow through on deciding for the patients, staff at GW Hospital hope to both save money and provide better patient care.
Patients who stay when they no longer need medical care, or for longer than average, cost GW Hospital millions of dollars, Patricia Dillard, the head of the Care Management Department at the GW Hospital, said. Those patients can stay for months or even a year, far longer than the average five-day stay for a regular patient, she said.
“If we have our beds held up with patients that are custodial, that limits our capabilities to provide services for those that are acutely ill,” Dillard said. “It really puts a bottleneck on the purpose of the hospital.”
Because elderly or mentally ill patients sometimes require a guardian to make decisions, like if the patient can be discharged from the hospital, it’s important for hospital officials to stay in touch with those guardians. Without that contact, the patients could end up overstaying their welcome, hurting both the hospital and themselves.
A group of local hospitals is also working to simplify the process for the D.C. Superior Court to appoint a guardian for a patient. Dillard said the process of appointing a guardian to a patient who has no available next-of-kin can take up to 45 days, a time when the patient would have to stay in the hospital without being discharged.
“The goal is to partner as much as we can with the court system so they can understand the entirety of this project,” Dillard said. “We want to bring everyone to the table and hold everyone accountable for these patients.”
Dillard said the hospital created a “guardianship kit” earlier this year to remind the legal guardians of their responsibilities when they need to make medical decisions. They also hired new staff, including case managers for patients who have guardians, who will keep tabs on the patients.
“We really ramped up our efforts to building a framework around the guardianship issue,” Dillard said.
Brendan Sinatro, the chief patient security officer for the D.C. Hospital Association, said patients who spend unnecessary amounts of time in the hospital could experience other medical issues like another illness or an accident like a fall.
“When the patient is ready to be discharged, that is when we run into a challenge,” Sinatro said. “Hospitals can be a dangerous place for healthy people.”
He said Dillard’s work at the GW Hospital will be used as a model for the others in the association.
“Why we got involved with this is because the hospital was seeing an increase in the amount of patients they had that were requiring a guardian,” Sinatro said. “The quantity wasn’t enormous but it was still significant because this population requires specific needs.”