Long-term acute care (LTAC) hospitals and units are becoming increasingly important to the management of patients who have serious, complex critical illnesses and require mechanical ventilation for extended periods of time. Kindred Healthcare, Inc., a nation-wide system of LTAC hospitals embarked on a quality initiative to establish a Ventilator Management and Weaning Best Practice. The process steps included: measurement of performance of all hospitals in the system using a risk-adjusted methodology to evaluate clinical outcomes, identification of facilities with superior outcomes; structured evaluation of the characteristics, practices, and protocols of these Best Practice hospitals; and utilization of the information gleaned from these hospitals to establish evidence-based LTAC best practice ventilator management guidelines. Key characteristics of the Best Practice LTAC hospitals were: hospital-wide philosophy that "everybody weans"-that is, all disciplines actively participate and all patients are expected to wean; collaborative multidisciplinary plans of care; a consistent and a 24-hour-a-day approach to ventilator management and weaning; daily communication; mutual respect for the contributions of all disciplines to the weaning process; early, aggressive nutrition support and intervention by rehabilitation services; use of 24-hour in-hospital advance practice nurses, hospitalists, or physician assistants; and intervention by physiatrists.
o the phrases workload management, patient classification system, and patient acuity tool send chills down your spine? If you picture double documentation that only annoys you, then you're not alone. Frustration over staffing, FTE budgets, nurse recruitment, and nurse retention is universal. Developing a fair, objective, and reliable way to predict the required number and skill level of staff to meet patient needs and staffing assignments contin-Abstract: Kindred Healthcare, Inc., the nation's largest full-service network of long-term acute care hospitals, initiated a 3-year strategic plan to re-evaluate its workload management system.Here, follow the project's most important and difficult phase-designing and implementing the patient classification system.
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