It's a typical day at the Encino-Tarzana Regional Medical Center. In the maternity ward of the hospital's Women's Pavilion, about 35 patients have just delivered babies. Another 14 women are in labor, about to give birth.
Nothing unusual about any of that, except for the fact that the hospital's maternity ward only has 29 beds.
The arithmetic of managing a maternity ward, challenging at best, is especially problematic for a hospital like the Encino-Tarzana center because of its small size. So the hospital has launched a program it hopes will help expand its capacity.
Moms who opt to give up one day of a hospital stay following delivery can receive three days of part-time home assistance with their newborn instead. (An early discharge also requires the approval of the attending physician.)
Freeing up beds once mothers have delivered not only helps the hospital ensure it doesn't run out of beds, it can also boost revenues.
"If we eliminate one day (of in-patient stay), that's 300 days a month," said Susan Woolley, director of maternal-child health for Encino-Tarzana Medical Center. "Then I can bring in many more patients on the front end where we make the most profit."
Under the program, which began as a pilot and is about to go into full swing, Encino-Tarzana subcontracts with Tender Care Doula Service Inc., a Valencia-based provider of home health care practitioners called doulas who are specially trained in the needs of mothers and their newborns. The doula, a Greek word that means something like "mother's mother," helps with everything from guidance on breast feeding to cooking meals and tending to other children or just giving the mother a chance to take a nap while someone else watches over the newborn.
Encino-Tarzana Medical Center began to test the program in October as a way to help relieve overcrowding and improve profitability. Originally built to serve the wealthy, the hospital now draws most of its patient population from managed care and other types of insurance contracts with lower reimbursement rates than those it derived from private patients.
"In the managed care environment, if they can get someone out of the hospital sooner and cut the cost, they're going to make more money," said Art Nemiroff, national director of health care advisory services for BDO Seidman LLP.
The hospital pays Tender Care $20 an hour for each doula it uses. That compares with $400 a day in the cost of meals, supplies, equipment and fixed costs in the hospital, Woolley said.
In addition to saving money on in-hospital stays, the program is expected to help Encino-Tarzana take on new business. By shaving one day off the stay of its maternity patients the hospital averages 300 deliveries a month it could add as many as 30 or 40 more deliveries each month, or $49,500 to $66,000 in revenues.
In 1997, California passed legislation that mandates minimum hospital stays following delivery 48 hours for a normal delivery and 96 hours for a caesarian section unless the mother opts to leave earlier. Many moms would prefer to go home quickly, but with families dispersed geographically, the grandparents, sisters and aunts who once pitched in while mom caught a few badly needed hours of rest, are often no longer available. Doulas can provide that added support.
"She's the perfect auntie," said Chris Morley, founder and president of Tender Care Doula Service.
Under the Encino-Tarzana program, doulas are assigned to work four hours a day during the first three days after a newborn is brought home. The time frame is somewhat arbitrary, Woolley concedes, but it can make a big difference in the mom's transition back home.
"We looked at that period of time when mothers are most challenged and most susceptible to depression," Woolley said. "They haven't had a good night's sleep. Their husbands are going back to work. We felt if we could get someone to help mom get off to a proper start, we would be giving them a leg up."
In the hospital, one nurse ministers to about 13 mothers. Specialists in lactating are only available on a part-time basis. And medications to relieve the pain of stitches are often placed at the mom's bedside so patients can apply the ointments themselves.
Doulas, who are all mothers themselves, receive 40 hours of training in breast feeding, post-partum depression and recognizing the symptoms of common ailments such as jaundice, so they provide the same support services a mom would receive in the hospital, on a one-on-one basis.
"It makes sense on two levels," said Nemiroff. "It sounds like a very astute program and probably offers the new mother some real benefits as opposed to lying in the hospital."
So far, because of limited availability of doulas during the pilot program, only about 10 percent to 20 percent of mothers have used the option. But in June the hospital will begin running its own doula program, using Tender Care to provide the curriculum and exams necessary for certification, with a larger staff.
In the short time the program has been running, Woolley said moms and doulas have established the kinds of long-term bonds that hearken back to the days when villages really did care for children. She believes that when more doulas are available, more moms will take advantage of the option.
The service not only helps the hospital's bottom line, it also helps deliver better care to maternity patients.
"We feel we're going to be reducing re-admissions to the hospital and reducing morbidity that could have resulted in additional medical service by being able to improve the environment in the home," Woolley said.
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