Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Hammond, Christina L; Phillips, Margaret; Pinnington, Lorraine; Pearson, Benedict J; Fakis, Apostolos

doi:10.1186/1472-6963-9-40

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…Most studies (n = 25) considered the general population of LTC residents; four studies focused on specific groups: residents with long-term neurological conditions [32], residents with advanced cognitive impairment [37], and residents at the end-of-life [31,39]. Mean age of the study samples ranged from 81 [31,41] to 86 years [37], and the proportion of women varied from 62% [15] to 80% [23].…”

Section: Resultsmentioning

confidence: 99%

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

et al. 2014

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BackgroundResidents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.MethodSystematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.ResultsTwenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.ConclusionsMost assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

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Section: Resultsmentioning

confidence: 99%

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

et al. 2014

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“…), test delays (Hammond et al . ), lack of home care and community services (Kozyrskyj et al . , Menec et al .…”

Section: Discussionmentioning

confidence: 99%

“…), inefficient discharge processes (Hammond et al . , Popejoy ), inefficient medical management (Brownell & Roos , Butler et al . , Guijarro et al .…”

Section: Discussionmentioning

confidence: 99%

A population‐based comparison of the use of acute healthcare services by older adults with and without mental illness diagnoses

Adams

Koop

Quan

et al. 2014

Psychiatric Ment Health Nurs

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Older adults with mental illness (MI) are a highly vulnerable population and need to be provided healthcare services in a timely and thorough way. Compared with older adults without MI, older adults with MI spend a great deal of time being hospitalized and hence costing millions of dollars because the care they need is often overlooked and/or not provided. While they end up spending too much time in hospital, in the emergency department and getting readmitted to hospital because of their MI, this could have been prevented or lessened if an adequate assessment and treatment regime was done by clinicians who were well informed on the topic of older adults' mental health. Older adults with MI are also more likely to leave hospital for long-term care settings, to die and to have more sickness compared with older adults who do not have MI. Further, they are also more likely to be admitted to hospital on an urgent, unplanned basis. How older adults with MI use acute hospitals is important for psychiatric nurses to know and understand, as they can help to provide the care needed so they do not have to be in hospital for long periods of time. Psychiatric nurses can share much support and information on making sure older adults with MI are accurately care for when needed. To explore and compare predictors of hospital length of stay (LOS), acute LOS (ALOS), emergency room (ER) wait times, rate of readmission (ROR) and costs of inpatient hospital care for older adults with and without mental illness (MI) diagnoses in the province of Newfoundland and Labrador (NL). This descriptive-comparative study used aggregate population level data of 12,283 people aged 65 years and older admitted to an acute care hospital in the province of NL. A total of 8.3% of hospitalized older adults had MI diagnoses. Older adults with MI diagnoses had a significantly longer LOS, ALOS, ROR, ER wait time and costs compared with older adults without MI diagnoses, after controlling for medical co-morbidities. Key variables such as patient demographics, admission indicators, discharge indicators and other medical co-morbidities had differential impacts on observed service use. While only a small percentage of hospitalized older adults had MI diagnoses, the use and cost of acute hospitalizations was significantly greater than that of older adults without MI diagnoses.

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“…Appropriateness of care is a major issue in provision of modern health services, and a large portion of delivered health care services could be considered as inappropriate [1]. Appropriateness is related to the quality of service and to the setting where care is provided [2].…”

Section: Introductionmentioning

confidence: 99%

The Short Stay Unit as a new option for hospitals: A review of the scientific literature

et al. 2011

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SummaryBackgroundThe short stay unit (SSU) is a ward providing targeted care for patients requiring brief hospitalization and dischargeable as soon as clinical conditions are resolved. Therefore, SSU is an alternative to the ordinary ward (OW) for the treatment of selected patients. The SSU model has been tested in only a few hospitals, and the literature lacks systematic evaluation of the impact of SSU use. The aim of our study was to evaluate the use of SSUs in terms of length of hospital stay, mortality and readmission rate.Material/MethodsA random effect meta-analysis was carried out by consulting electronic databases. Studies were selected that focused on comparison between use of SSUs and OWs. Mean difference of length of stay was calculated within 95% confidence intervals.ResultsSix articles were selected, for a total of 21 264 patients. The estimated mean difference was −3.06 days (95% CI −4.71, −1.40) in favor of the SSU. The selected articles did not show any differences in terms of mortality and readmission rate.ConclusionsUse of SSUs could reduce patient length of stay in hospital, representing an alternative to the ordinary ward for selected patients. A shorter period of hospitalization could reduce the risk of hospital-acquired infections, increase patient satisfaction and yield more efficient use of hospital beds. Findings of this study are useful for institutional, managerial and clinical decision-makers regarding the implementation of the SSU in a hospital setting, and for better management of continuity of care.

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Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Cited by 14 publications

References 26 publications

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

A population‐based comparison of the use of acute healthcare services by older adults with and without mental illness diagnoses

The Short Stay Unit as a new option for hospitals: A review of the scientific literature

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