Length of Stay in Skilled Nursing Facilities Following Total Joint Arthroplasty

2017 ◽  
Vol 32 (2) ◽  
pp. 367-374 ◽  
Author(s):  
Brandon A. Haghverdian ◽  
David J. Wright ◽  
Ran Schwarzkopf
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 26
Author(s):  
Christopher Fang ◽  
Andrew Hagar ◽  
Matthew Gordon ◽  
Carl T. Talmo ◽  
David A. Mattingly ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Hospital Costs ◽  
Cost Effective ◽  
Joint Arthroplasty ◽  
Nursing Facilities ◽  
Activity Based Costing ◽  
Skilled Nursing ◽  
Value Based Care ◽  
Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

Ownership Status and Length of Stay in Skilled Nursing Facilities

2015 ◽  
Vol 35 (3) ◽  
pp. 303-320 ◽  
Author(s):  
John R. Bowblis ◽  
John Horowitz ◽  
Christopher S. Brunt
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Ownership Status

scholarly journals 2492 Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization

2018 ◽  
Vol 2 (S1) ◽  
pp. 87-87
Author(s):  
Himali Weerahandi ◽  
Li Li ◽  
Jeph Herrin ◽  
Kumar Dharmarajan ◽  
Lucy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hazard Rate ◽  
Skilled Nursing Facilities ◽  
Unplanned Readmission ◽  
Time Interval ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Heart Failure Hospitalization ◽  
Skilled Nursing

OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1–6 days, 7–13 days, 14–30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0–3 days post SNF discharge and 4–30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78–89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11–22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3–18). The hazard rate of readmission for each group was significantly increased on days 0–3 after discharge from SNF compared with days 4–30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0–3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF.

scholarly journals Factors Determining Home versus Rehabilitation Discharge Following Primary Total Joint Arthroplasty for Patients Who Live Alone

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 7 ◽  
Author(s):  
Christopher Fang ◽  
Sara J. Lim ◽  
David J. Tybor ◽  
Joseph Martin ◽  
Mary E. Pevear ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Tertiary Care ◽  
Joint Arthroplasty ◽  
Future Research ◽  
Discharge Destination ◽  
Nursing Facilities ◽  
Academic Hospital ◽  
Skilled Nursing ◽  
Hip And Knee Arthroplasty ◽  
Discharge Location

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.

Abstract WP351: Using Standard Work to Improve the Discharge Process on a Neurology Division

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Rose M Donnelly ◽  
Tim Tranor ◽  
Julie Griffin ◽  
Kalcee Foreman ◽  
Adrienne Ford ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multidisciplinary Team ◽  
Skilled Nursing Facilities ◽  
Multidisciplinary Teams ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Mobile Computer ◽  
Skilled Nursing ◽  
Standard Work ◽  
Inadequate Information

Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

scholarly journals Waiving The Three-Day Rule: Admissions And Length-Of-Stay At Hospitals And Skilled Nursing Facilities Did Not Increase

2015 ◽  
Vol 34 (8) ◽  
pp. 1324-1330 ◽  
Author(s):  
Regina C. Grebla ◽  
Laura Keohane ◽  
Yoojin Lee ◽  
Lewis A. Lipsitz ◽  
Momotazur Rahman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals The congressional mandate: standardised post-acute care quality measures

2019 ◽  
Vol 26 (8) ◽  
pp. 1-10
Author(s):  
Christine Kroll ◽  
Thomas Fisher
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Functional Outcomes ◽  
Care Quality ◽  
Skilled Nursing Facilities ◽  
Rehabilitation Services ◽  
Nursing Facilities ◽  
Data Set ◽  
Skilled Nursing ◽  
Post Acute Care

Background/Aims This study describes the relationships between rehabilitation services intensity, post-acute care measures of Functional Performance Change, and length of stay for episodes of care provided in 93 skilled nursing facilities in the US. Methods The study used a secondary analysis of existing data on Medicare beneficiaries admitted to skilled nursing facilities from acute hospitals (n=518) who subsequently returned to the community. Data were selected from Minimum Data Set Section GG items reported by therapists. Results Statistically significant correlations were identified between rehabilitation services intensity and functional outcomes (P<0.001); and between rehabilitation intensity, medical condition, and length of stay (P<0.001) for rehabilitation patients in skilled nursing facilities. Conclusions The intensity of occupational and physical rehabilitation therapy services correlate with patients achieving higher functional outcomes, specifically improvement in self-care and mobility.

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