Relevance of the diagnosis 'stage 1 pressure ulcer': an empirical study of the clinical course of stage 1 ulcers in acute care and long-term care hospital populations

Abstract Background Urine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown. Methods This was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented. Results In acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs. Conclusion Reflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.

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Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2009.03024.x ◽

2010 ◽

Vol 16 (7) ◽

pp. 934-944 ◽

Cited By ~ 108

Author(s):

A. March ◽

R. Aschbacher ◽

H. Dhanji ◽

D.M. Livermore ◽

A. Böttcher ◽

...

Keyword(s):

Acute Care ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Facility ◽

Care Hospital ◽

Term Care ◽

Long Term Care Facility ◽

Geriatric Unit ◽

Multiresistant Bacteria

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Agitation in Demented Patients in an Acute Care Hospital: Prevalence, Disruptiveness, and Staff Burden

International Psychogeriatrics ◽

10.1017/s1041610201007578 ◽

2001 ◽

Vol 13 (2) ◽

pp. 183-197 ◽

Cited By ~ 67

Author(s):

Rosa Sourial ◽

Jane McCusker ◽

Martin Cole ◽

Michal Abrahamowicz

Keyword(s):

Acute Care ◽

Nursing Staff ◽

Barthel Index ◽

Long Term Care ◽

Acute Care Hospital ◽

Patient Characteristics ◽

Care Hospital ◽

Term Care ◽

Research Attention

Background/literature review: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff. Method: The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints. Results: Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden. Discussion: The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.

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Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa129 ◽

2020 ◽

Vol 27 (8) ◽

pp. 1206-1213 ◽

Cited By ~ 1

Author(s):

Julia Adler-Milstein ◽

Katherine Raphael ◽

Alice Bonner ◽

Leslie Pelton ◽

Terry Fulmer

Keyword(s):

Older Adults ◽

Electronic Health Record ◽

Acute Care ◽

Long Term Care ◽

Health Record ◽

Care Hospital ◽

Term Care ◽

Care Facilities ◽

Electronic Health

Abstract Objective To measure US hospitals’ adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. Materials and Methods In an online survey of a national, random sample of 797 US acute-care hospitals in 2018–2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. Results Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). Discussion Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. Conclusions US acute-care hospital EHRs are lacking key functions that support care for older adults.

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Clostridium difficileInfection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

Infection Control and Hospital Epidemiology ◽

10.1086/660767 ◽

2011 ◽

Vol 32 (7) ◽

pp. 656-660 ◽

Cited By ~ 41

Author(s):

Jong Hun Kim ◽

Diana Toy ◽

Robert R. Muder

Keyword(s):

Acute Care ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Facility ◽

Optimal Strategies ◽

Care Hospital ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility

Background.Controversy exists over whetherClostridium difficileinfection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.Objective.To assess the incidence and outcome of CDI in a long-term care facility.Methods.Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stoolC. difficiletoxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.Results.The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P= .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%;P= .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07;P= .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95;P= .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05;P= .005) were associated with relapse of CDI.Conclusions.Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

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