Evaluation of Critically Ill Patients for Transfer to Long-term Acute-care Facilities

Lusk, Ruth; O’Bryan, Linda

doi:10.1097/00129234-200201000-00005

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…From July 28, 2005, through November 1, 2008 (39 months), a total of 1,905 sets of cultures were performed; 166 sets of cultures were removed from the analysis, because the specimens were collected from 24 hours to 30 days after the collection of the patient's original set. A total of 5,198 individual cultures of specimens from 1,739 patients were analyzed (mean, 2.9 cultures per patient). Of the 5,198 individual cultures, 1,580 (30%) were positive for MDROs, and 947 (54%) of the total 1,739 patients had a culture-positive specimen recovered from any site.…”

Section: Resultsmentioning

confidence: 99%

“…Qualifying conditions for admission to LTACHs include mechanical-ventilator weaning, long-term intravenous antibiotics, parenteral feeding, and complex wound care. [3][4][5] Patients hospitalized at LTACHs have multiple comorbidities, including recent intensive care unit admissions, surgeries, intravenous antibiotics, and long lengths of stay at their acute care hospitals of origin; these characteristics place this population at high risk for carriage of multidrug-resistant organisms (MDROs) on admission to LTACHs. 4,6 During the past few years, the number of LTACHs in the United States has increased to nearly 400.…”

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confidence: 99%

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Four Years of Surveillance Cultures at a Long-Term Acute Care Hospital

Munoz-Price

Stemer

2010

Infect. Control Hosp. Epidemiol.

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A total of 1,739 patients with a total of 5,198 specimens met entry criteria. Of the corresponding 5,198 surveillance cultures, 1,580 (30%) were positive for MDROs. Of the 1,739 patients, 947 (54%) had a culture-positive specimen recovered from any site. Vancomycin-resistant Enterococcus was the organism most commonly isolated in cultures of rectal swab samples (in 38% of such cultures) and wounds (in 18% of such cultures). The rate of rectal carriage of vancomycin-resistant Enterococcus increased from 29% in 2005 to 44% in 2008.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Four Years of Surveillance Cultures at a Long-Term Acute Care Hospital

Munoz-Price

Stemer

2010

Infect. Control Hosp. Epidemiol.

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“…6 For acute care hospitals, resource utilization has become one of the primary incentives in facilitating the transfer of hemodynamically stable patients receiving mechanical ventilation out of the ICU setting. 7 Transfer of patients who require prolonged mechanical ventilation to LTCHs could achieve substantial cost savings for short-term acute care hospitals and help with other operational benefits by increasing access to new admissions. 6,8 However, discharge planning poses challenges.…”

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confidence: 99%

A Simplified Score for Transfer of Patients Requiring Mechanical Ventilation to a Long-Term Care Hospital

Chen¹,

Vanness²,

Golestanian³

2011

American Journal of Critical Care

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Background Long-term care hospitals are Medicare providers of postacute care that have a mean length of stay of 25 days or more. Early identification and timely transfer of patients requiring mechanical ventilation to such hospitals may improve the efficiency of inpatient care. Objectives To develop a predictive model and a simplified score for use on day 7 of hospitalization to assess whether a patient receiving mechanical ventilation is likely to require an additional 25 days of hospitalization (ie, would qualify for transfer to a long-term care hospital). Methods A retrospective, cross-sectional study using hospital discharge and billing data from the 2005 Nationwide Inpatient Sample for 54 686 Medicare beneficiaries admitted to US community hospitals who met the study's eligibility criteria. The outcome was overall length of stay (≥32 vs <32 days). Split-sample validation was used. Multivariable survey-logistic regression analyses were performed to assess predictors and probability of the outcome. A simplified score was derived from the final predictive model. Results The discriminatory power of the predictive model was 0.75 and that of the simplified score was 0.72. The model calibrated well. All predictors were significantly (P < .01) associated with a hospitalization of 32 days or longer; having a tracheostomy was the strongest predictor (odds ratio, 4.74). The simplified scores ranged from -5 to 110 points and were categorized into 3 classes of risk. Conclusions Efforts to aid discharge decision making and optimize hospital resource planning could take advantage of our predictive model and the simplified scoring tool.

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“…Patients admitted to an LTACH often require intravenous antibiotics through central vascular catheters (CVCs), ventilator weaning, or daily wound care and physical therapy. 7 In the past, these patients would have remained in the hospital until the completion of those therapies; however, to decrease the costs of acute care hospitalization, in 1993, Medicare exempted LTACHs from the prospective payment system; this decision was reversed in 2003. 8 The average length of stay in LTACHs across the United States, as required by Medicare, is 25 days or longer.…”

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confidence: 99%