How do Treat-in-Place protocols work in skilled nursing?
A treat-in-place protocol is a structured way to manage a resident's change in condition inside the facility when it is safe to do so. A licensed clinician assesses the resident with the nurse, orders treatment and monitoring, and documents the encounter in the resident's chart. Residents who need hospital care are still transferred.
What "treat in place" means
Treat in place means managing a resident's acute change in condition in the facility instead of sending them to the emergency department, when that can be done safely. A licensed clinician makes that call case by case, after assessing the resident. The protocol makes sure the decision follows the same careful steps every time, which matters most after hours when no clinician is on site.
How the protocol works after hours
1. Assessment
The nurse recognizes the change, assesses the resident, and requests a consult from a tablet. A licensed Third Eye Health clinician joins by video, on average within 2 to 5 minutes, and reviews what the nurse is seeing.
2. Decision
The clinician determines whether the resident can be treated safely in the facility. That judgment weighs the resident's symptoms and vital signs, what the facility can provide overnight, and the resident's goals of care and advance directives.
3. Treatment and monitoring
If treating in place is appropriate, the clinician gives orders and a monitoring plan, such as when to recheck vital signs and which changes should prompt another call. The nurse carries out the plan, and if the resident's condition shifts later in the night, the nurse can request another consult the same way.
4. Documentation and follow-up
Notes and orders sync into the resident's chart, the attending physician gets a warm handoff, and daily care coordination summaries keep the day team informed. Encounters are covered by Third Eye Health's quality oversight. See each step of an after-hours consult in more detail.
Conditions that are often treated in place
Examples may include:
• Delirium or new confusion
• Minor infections
• Falls without major injury
• Early warning signs of acute conditions
Whether a specific resident can be treated in place always depends on the clinician's assessment and what the facility can safely provide.
When a resident should still go to the hospital
Emergencies and higher-acuity situations are escalated without delay. That includes signs of a stroke or heart attack, serious injury from a fall, severe trouble breathing, or any situation where the resident needs care the facility can't provide. In those cases the clinician recommends transfer right away and documents the reasoning.
Why it matters
Treating residents in place when it is safe spares them the stress and risks of an emergency department visit and keeps them with staff who know them. Across Third Eye Health partner facilities, the average treat-in-place rate is 93%.
Related: How does virtual clinician coverage reduce ER transfers? To see how this would work in your building, request a demo.
Frequently asked questions
Which conditions are eligible?
Examples may include delirium, minor infections, falls without major injury, and early warning signs of acute conditions when in-place management is clinically appropriate.
Who decides whether a resident is treated in place?
A licensed Third Eye Health clinician, after assessing the resident with the nurse over video. The decision takes into account the resident's condition, goals of care and what the facility can provide.
What happens if the resident doesn't improve?
The nurse can request another consult at any point during the night. If the resident's condition worsens, the clinician reassesses and escalates care when needed.
How is the attending physician kept informed?
Third Eye Health clinicians give the attending physician a warm handoff, and the encounter's notes and orders are already in the resident's chart.
