scholarly journals Implications of decreasing surgical lengths of stay

2000 ◽  
Vol 23 (2) ◽  
pp. 62 ◽  
Author(s):  
Neville Board ◽  
Gideon Caplan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Health Outcomes ◽  
Acute Care ◽  
Resource Use ◽  
Clinical Pathways ◽  
High Volume ◽  
Early Discharge ◽  
Lengths Of Stay ◽  
Day Of Surgery Admission ◽  
Post Acute Care

A recent study at the Prince of Wales Hospital (PoW) compared health outcomes and user satisfactionfor conventional clinical pathways with a shortened pathway incorporating day of surgery admission(DOSA), early discharge and post acute care domiciliary visits for two high volume, elective surgicalprocedures (herniorrhaphy and laparoscopic cholecystectomy). This paper quantifies cost differencesbetween the control and intervention groups for nursing salaries and wages, other ward costs, pathologyand imaging.The study verified and measured the lower resource use that accompanies a significant reduction inlength of stay (LOS). Costs of pre- and post-operative domiciliary visits were calculated and offsetagainst savings generated by the re-engineered clinical pathway. Average costs per separation were atleast $239 (herniorrhaphy) and $265 (laparoscopic cholecystectomy) lower for those on the DOSApathway with domiciliary post acute care.

Post acute care: Can hospitals do better with less?

1997 ◽  
Vol 20 (2) ◽  
pp. 43 ◽  
Author(s):  
Gideon A Caplan ◽  
Ann Brown
Keyword(s):  
Cost Effectiveness ◽  
Length Of Stay ◽  
Acute Care ◽  
Early Discharge ◽  
Government Funding ◽  
Discharge From Hospital ◽  
Post Acute Care

Judging by reports in medical magazines and journals, ?early discharge schemes?, bettertermed ?post acute care?, are not popular with doctors. However, government policyencourages earlier discharge from hospital, so that the choice facing clinicians is todischarge patients early with support, or early without support, or deal with theconsequences of length of stay overruns. Fortunately, government funding for post acutecare is increasing. There is a strong rationale for post acute care based on better patientoutcomes and cost-effectiveness, but these desirable results will only be achieved ifscrupulous attention is paid to detail, as embodied in the 10 principles of post acutecare. To function optimally, post acute care should be coordinated by the hospitalwhich provided the acute care.

Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil

2017 ◽  
Vol 35 (2) ◽  
pp. 198-202
Author(s):  
Luiz Guilherme L. Soares ◽  
André M. Japiassu ◽  
Lucia C. Gomes ◽  
Rogéria Pereira
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Care Facility ◽  
Discharge Destination ◽  
Care Needs ◽  
Care Services ◽  
Lengths Of Stay ◽  
Hospital Stays ◽  
Acute Care Facilities ◽  
Post Acute Care

Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.

New Post-Acute Care Quality Measures Take Effect Oct. 1

ASHA Leader ◽  
2016 ◽  
Vol 21 (6) ◽  
pp. 34-35
Author(s):  
Sarah Warren ◽  
Tim Nanof
Keyword(s):  
Acute Care ◽  
Quality Measures ◽  
Care Quality ◽  
Post Acute Care

Moving in, taking charge in the post-acute care realm

2013 ◽  
Vol 6 (2) ◽  
pp. 1-25
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Acute Care ◽  
Taking Charge ◽  
Post Acute Care

Integrating Palliative Care Assessment Tools to Enhance Understanding of Illness Trajectory in Post-Acute Care and Long-Term Care

2021 ◽  
pp. 104990912110181
Author(s):  
Daphna Grossman ◽  
Yona Grossman ◽  
Ezra Nadler ◽  
Mark Rootenberg ◽  
Jurgis Karuza ◽  
...  
Keyword(s):  
Acute Care ◽  
Chart Review ◽  
Assessment Tools ◽  
Illness Trajectory ◽  
Illness Burden ◽  
Palliative Approach ◽  
Interprofessional Care ◽  
Care Assessment ◽  
Understanding Of Illness ◽  
Post Acute Care

Objectives: To determine whether education and integration of the Gold Standard Framework Proactive Identification Guidance (GSF-PIG) and the Palliative Performance Scale (PPS) into care rounds, in post-acute care settings, can facilitate communication between the interprofessional care team to enhance understanding of illness trajectories, identifying those who would benefit from a palliative approach to care. Methods: Interprofessional care teams received training on the GSF-PIG and PPS which were integrated into weekly care rounds and completed a post-evaluation survey. A chart review was conducted for the 40 patients and residents reviewed with the GSF-PIG and PPS. Data analysis included descriptive statistics and comparisons of characteristics between patients and residents who were grouped as positive or negative on the GFS-PIG surprise question using chi square analyzes and t-tests. Results: The GSF-PIG and PPS were found to enhance communication within care teams and enhance understanding of patient and resident’s illness burden. The chart review revealed that patients and residents whom the team would not be surprised if they died within 1 year were older (p = .002), had a lower PPS score (p = .002) and had more indicators of decline (p < .001) compared to patients and residents the team would be surprised if they died within the year. Conclusion: Training interprofessional care teams on the utilization and integration of the GSF-PIG and PPS during weekly care rounds helped increase the understanding of patient and resident illness burden and illness trajectory to identify those who may benefit from a palliative approach to care.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

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