The Goldilocks Protocol: Why the Right Bed is Critical for Discharge

by Mary Kay Thalken, RN, MBA on Mar 29, 2018


Remember the story of Goldilocks? Here’s a quick refresher: girl is walking through the woods and stumbles upon three beds. One of the beds is too hard, the other is too soft, but finally, she finds a bed that’s “just right.”

She later gets chased off by a family of bears. But we’re going to skip that part.

Before her ignominious escape, Goldilocks isn’t satisfied with whatever happens to be available. She’s looking for a place to stay and finds something that’s less than perfect. She knows her back will be way too sore the next morning if she sleeps in the hard bed, that she’ll toss and turn all night if she sleeps in the bed that’s too soft.

She demands more and continues looking until she finds the bed that will provide her with an ideal sleeping experience.

Can your facility say the same when it comes to finding a bed for patients who need post-acute care?

It's Not Enough to Just Find a Bed!

I encourage you to establish your own Goldilocks Protocol at your organization.

We understand that, for a lot of patients, finding a bed, any bed, at an acceptable post-acute care facility is in itself a difficult task. There may be a limited number of facilities, those places that are capable could have demand that far exceeds their available supply, and you as an organization understand the financial ramifications of another night’s stay. This creates a situation that puts the pressure on to move your patients out as fast as possible.

But in this era of value-based payment models and penalties for length of stay and readmissions, it’s more important than ever that discharge planners find the right bed for the patient.

“The Goldilocks Protocol” isn’t a pipe dream or a Robert Ludlum novel. It represents where we as an industry need to go in order to better serve patients. It signifies a commitment to doing more than just the bare minimum to get a patient transitioned to a different facility. It’s a set of processes that ensures they’re referred to the right facility and able to get both the care they require and the personal support they need.

Ready to make that commitment? Here are a few steps you’ll need to consider.

Improved Categorization

First, you need a good understanding of the facilities in your area willing and able to accept your patients and, most importantly, provide the services and support they need. This includes facilities nearby, as well as those that are well outside your zip code.

Facilities open and close regularly and keeping your database up to date can be an unwieldy process if you’re not prepared. What’s more, facilities may opt to shift the types of care they offer without warning. When these closings, openings and evolutions occur, that information doesn’t always carry downstream to the hospitals and case managers overseeing discharge referrals.

The first step to combat this problem is to take stock of the facilities you currently refer to, followed by those you may conceivably discharge a patient to in the future. With that done, you can begin categorizing these by the types of care they offer, distance to your facility, insurance they take, quality ratings, etc.

By improving the way you categorize facilities, you’ll have a better sense of what “the right bed” is for a patient and who might have that bed available.

Evolve Your Process

Goldilocks had it easy. She had three beds to choose from and made an educated decision based off the limited choices she had.

You probably don’t have this benefit. Instead, you could be dealing with dozens of facilities or, worse yet, none that you can identify as the right fit for your hard-to-place patient.

In order to make sure you’re sending patients precisely where they need to go rather than just throwing a proverbial dart, you need to take a long, hard look at your processes and identify areas for potential improvement.


Let’s start with how you communicate with facilities. Are you sending a fax, placing a phone call or instant-messaging them? The fax takes the longest, the phone is little better, and the instant messaging system allows you to be most efficient. If you’re faxing or calling, you’re immediately hamstrung because you can’t be in touch with the number of facilities you might need to contact in order to place the patient in the perfect bed.

So that’s the first step. From there, you should look at how you present the prospective post-acute care choices to the patient. Look at not just what details are provided, but at whether or not you can honestly say that the patient is receiving and retaining that information.

That’s a subtle but major difference. A Social Worker or case manager may feel like the way they’ve transmitted information to the patient has left nothing to chance, but your patient’s mind could have been elsewhere, they may have misconstrued what they heard, or they might have just nodded along and said ‘Yes’ to anything because they just want to get out of the hospital at this juncture.

How you communicate to post-acute care facilities, patients and patients’ families matters, and it will go a long way toward identifying the perfect bed.

The Right Tools for the Job

The final step is determining whether or not you have the right personnel, infrastructure and software to handle the important job of referring and placing patients.

The post-acute discharge process can become convoluted quickly, particularly if the systems currently in place grew organically rather than strategically. Many facilities arrive at their current system due to an evolution over the course of time, but when you take a look at it with fresh eyes, you may discover opportunities for improvement.

Software solutions, for instance, can be a boon to your “Goldilocks Protocol.” The right software enables you to communicate effectively with post-acute care facilities as well as keep everyone on the care team on the same page. It can open the door to a new era of communication, enabling you to use the latest technology, i.e. a tablet or a monitor as opposed to a ream of paper, when presenting prospective facilities to patients.

Having these tools in place goes a long way toward fulfilling the commitment to placing patients not just in any bed, but in the right bed. Goldilocks may be the most simplified version of this ideal, but it’s certainly something to aspire to in the modern world.

The post-acute discharge process is an incredible opportunity for upside for your organization, a means of improving the patient experience and the level of care your patients receive.

It’s time to establish a set of parameters that will make things not too hard, not too soft, but…just…right.

How much can your organization save with automated discharge technology? Calculate your ROI.

Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.