April showers, sunshine, and spring!
April gets its name from the Latin aperio, meaning “to open” or “bud” … as in flowers! From the Cherry Blossoms in Seattle (peaking around the third week of March, followed by the Seattle Cherry Blossom and Japanese Cultural Festival, April 11-13) to the Skagit Valley Tulip Festival (from April 1 to 30), flowers are starting to bloom! Fun fact: In 1892, before they had the right to vote, Washington women selected the coast (Pacific) rhododendron as the state flower to enter a floral exhibit at the 1893 World’s Fair in Chicago. In 1959, the Legislature designated it as the official flower of the state of Washington.
This month’s topics include a few length of stay updates and some important reminders and documentation requirements for the use of restraints and/or seclusion.
1) Length of Stay Updates: Flashback!
a) For 2024’s April Newsletter, I wrote: Length of Stay improved at both ministries! Our Financial Length of Stay (FLOS) at St. Peter improved from 6.8 in February to 6.51 in March (projected) and at Centralia from 5.4 to 4.85 (projected).
b) To demonstrate our progress… our FLOS/Acute LOS for February to March 2025 also improved at both ministries. While March hasn’t quite finalized, our LOS improved at St. Peter from 6.17 days in February to 6.09 days in March and at Centralia from 4.73 to 4.32 days (projected data for March as of April 5 at both ministries).
c) The comparison year over year is impressive; additionally, that LOS difference allowed us to care for 192 additional admissions between February and March 2025 at St. Peter Hospital (157 more admissions than March 2024). Your LOS contributions translate directly into more patients getting the right care, in the right setting, at the right time. Thanks for your hard work!
d) How can you help continue this work? Plan for discharge starting at admission, encourage mobility and discussions around anticipated discharge date, consider discharge home as the most common and ideal discharge location for most of our patients, and always discuss discharge plan B with patients and their families.
2) Important reminders regarding the use of restraints/seclusion: Requirements and Documentation
a) WA state hospitals are required to adopt, implement, review and revise patient care policies and procedures designed to guide staff that address: (f) the use of physical and chemical restraints or seclusion consistent with Code of Federal Regulations (CFR) 42.482 (WAC 246-320-226)
b) PSPH Policy Number 86100-PCS-126 Restraint and Seclusion (and more recently, PSJH-CLIN-1216 and PSJH-CLIN-1217, effective June 6, 2025) establish guidelines for the use of restraints and/or seclusion and ensure our compliance with Centers for Medicare and Medicaid Services (CMS) Conditions of Participation and compliance with other regulatory entities and standards around the use of restraint and/or seclusion. Key reminders include:
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- Restraint is any method (chemical or physical) of restricting the freedom of movement of an individual served to manage their behavior.
- Restraint and/or seclusion will be utilized only when other less restrictive clinical
interventions have been ineffective - Use is based on a comprehensive, individualized patient assessment, not a diagnosis.
- Use of restraints for non-violent, non-self-destructive behavior/medical care support is justified when used to meet patient’s individual clinical needs – pulling of lines/drains and requires type (of restraint), location (RUE, LUE, etc.), time limit, and criteria for release as well as face-to-face assessment within 24 hours of initiation and daily until discontinued.
- Use of restraint and seclusion for violent or self-destructive behavior is limited to emergencies in which there is an imminent risk of physical harm to self, staff or others and non-physical interventions would not be effective. Orders must include type, time limit and require face-to-face evaluation within one hour of the application of restraints or seclusion. The findings of the physical and behavioral assessment must be documented in the medical record by the physician or APC (Attending) within the one-hour period, even if removed within one hour of application.
- Patient must be released immediately upon cessation of the behavior that preceded the need for restraint.
- In our state, restraints including physical and chemical restraints are permitted only as a last resort to ensure the safety of the individual or others and only when there is an imminent likelihood of serious harm and when less restrictive measures have been ineffective.
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