“Offense sells tickets. Defense wins championships.”
-Paul “Bear” Bryant
Happy February! I hope you enjoyed watching our Seattle Seahawks CRUSH the Patriots 29-13 in Super Bowl LX as much as I did. While I have heard from some that the game this year was boring… it was nice to see good old blocking and tackling (including 6 QB sacks and 2 interceptions!). Standouts like MVP Kenneth Walker III (with a season-high 27 carries) and Jason Myers (who made the only points across three quarters as the kicker!) demonstrated that consistency and excellence are critical to scoring (and winning)! Go Hawks!
Some of the key components to our offense and defense for 2026 are verifying your privileges (they are a privilege!), strengthening restraint documentation, and throughput (getting comfortable with geometric mean length of stay).
1) Privileges… they are a privilege! Medical Staff privileges are essential to ensuring patient safety, maintaining high-quality care, and meeting regulatory standards. Privileges authorize only qualified professionals to perform specific clinical procedures. These privileges define a provider’s permitted scope of practice within a facility.
a) The big why? When I trained as an ObGyn, we performed newborn circumcisions (because that’s who did them where I trained). I did the required number and was granted the privilege (long ago). As I went to facilities where there were pediatricians and/or Family Medicine physicians who did that work, thankfully they didn’t need me to do them anymore (and I shouldn’t be doing them now for sure!) Privileges are what allow me within my field of expertise to do some things and not others based on my training and competency, also within the scope of practice at my facility. Providers cannot bill for procedures performed without possessing the privilege. Credentialing is verifying background, education, training, licensure and experience to be qualified to practice medicine, while privileging answers the what – what is this provider qualified and authorized to do in our hospital? You can find this information in your board letter and at the website here for St. Peter Hospital and here for Providence Centralia Hospital. If you have questions, please reach out to our Medical Staff Office at (360) 493-7360.
2) Restraint Documentation Requirements: Most common regulatory findings (TJC/DOH) During our core survey, we identified gaps around restraint documentation. These are the most common findings (Click here for links to more information including regulatory requirements):
a) Violent Restraints/Seclusion: Orders and Face-to-Face Required
i) Orders missing or order does not match indication or applied restraints (non-violent restraints ordered for violent indication, two-point restraints used when four-point restraints ordered, etc.)
ii) Timing (more than 30 minutes before or more than 15 minutes after episode initiation)
iii) Re-order missing
iv) Re-order too late (outside regulatory timeframe for patient’s age)
v) Face-to-face evaluation: not completed and/or too early (before initiation) or too late (>1hr of episode initiation)
b) Non-violent restraints: Order or re-order missing or improperly timed (more than 30 minutes before or more than a few minutes after episode initiation; not rewritten every 24 hours afterward)
3) Throughput and Efficiency: Getting more comfortable with GMLOS!
Kudos on your work around throughput and length of stay for 2025. We closed the year sporting an impressive 13% reduction in length of stay that resulted in serving more patients than the prior year. Remember, our length of stay isn’t just a number, it’s a comparison of how effectively we deliver safe, high-quality care to patients and get them to their next site of care, ideally back home for most of our patients. For 2026 we will be looking more closely at specific diagnoses and workflows. As an example, the GMLOS (Geometric Mean Length of Stay) for a patient with Heart Failure (DRGs 291, 292, and 293) is 3.9 days. For patients with that diagnosis who go home, our target O:E is less than 1 (we try to care for most patients efficiently through our system in less than 3.9 days). For patients going to other locations (SNF, etc.) we expect them to take longer than 3.9 days. What elements of the care for most of our heart failure patients have to happen when in order to get them home in 3.9 days or less?
