Acute rehospitalisation during the first 3 months of in-patient rehabilitation for traumatic brain injury

2016 ◽  
Vol 40 (1) ◽  
pp. 114 ◽  
Author(s):  
Nalinda Andraweera ◽  
Richard Seemann
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
Pearson Correlation ◽  
Acute Care Hospital ◽  
Functional Independence ◽  
Care Hospital ◽  
Injury Rehabilitation ◽  
Number Of Patients ◽  
Tract Infections

Objective Unplanned re-admission to acute care hospitals during in-patient rehabilitation causes disruption to the rehabilitation program and increases the cost of health care. The aims of the present study were to identify the frequency, reasons and duration of disruption to rehabilitation because of acute re-admissions during the first 3 months of in-patient rehabilitation for traumatic brain injury (TBI) and to investigate the correlation between the duration of acute rehospitalisation and the discharge functional independence measure (FIM) score. Methods A retrospective study was conducted on patients admitted for in-patient rehabilitation following TBI to a rehabilitation hospital in Auckland, New Zealand, between January 2009 and August 2013. Data on duration and reasons for acute rehospitalisation, as well as admission and discharge FIM scores, were obtained from electronic patient records. Pearson correlation was used to evaluate the relationship between the duration of acute rehospitalisation and the discharge FIM score. Results Of the 628 patients admitted for brain injury rehabilitation, 71 (11.3%) required acute rehospitalisation within the first 3 months. The main reasons for acute rehospitalisation were preventable medical causes (43.8%), including urinary tract infections, respiratory tract infections and coronary artery disease. Of the acute re-admissions, 76.6% were within the first month of admission to the rehabilitation centre and 46.6% needed in-patient treatment in the acute care hospital for >5 days. There was a moderately strong negative correlation between the duration of stay in the acute care hospital and the discharge FIM score (r = – 0.412; P = 0.0005). Conclusion A significant number of patients admitted for in-patient rehabilitation following TBI require acute rehospitalisation due to preventable medical causes. Because the duration of acute rehospitalisation has a negative impact on rehabilitation functional gain, preventive measures and surveillance need to be further investigated and optimised. What is known about the topic? The incidence of acute rehospitalisation of patients in the community following brain injury rehabilitation is 20%–25%, with approximately half the re-admissions being for elective reasons, including orthopaedic and reconstructive surgery. What does this paper add? Unplanned acute rehospitalisation during first 3 months of in-patient rehabilitation following TBI is due to preventable causes and results in lower FIM scores on discharge. What are the implications for practitioners? An uninterrupted rehabilitation programme is vital for achieving functional outcomes.

scholarly journals Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury

2015 ◽  
Vol 96 (8) ◽  
pp. S293-S303.e1 ◽  
Author(s):  
Flora M. Hammond ◽  
Susan D. Horn ◽  
Randall J. Smout ◽  
Cynthia L. Beaulieu ◽  
Ryan S. Barrett ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Inpatient Rehabilitation ◽  
Care Hospital

scholarly journals Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a non-equivalent control group design

2021 ◽  
Author(s):  
Nina Weldingh ◽  
Marte Mellingsæter ◽  
Bendik Hegna ◽  
Jūratė Šaltytė Benth ◽  
Gunnar Einvik ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Control Group ◽  
Care Hospital ◽  
Control Group Design ◽  
Group Design ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
Equivalent Control

Abstract Background Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the prevalence of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. Methods This study had a non-equivalent control group design and a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the Four Assessment Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from patient journals. Results Implementation of the dementia-friendly hospital program did not show any significant effect on the identification of patients with CI. However, the proportion of the patients with CI who received preventive measures increased by 32.2% (P < .001), compared to the control group. The share of patients screened with 4AT within 24 hours increased from 0–35.5% (P < .001). Furthermore, the number of patients with CI who were prescribed antipsychotic/hypnotic medications was reduced by 24.5% (P < .001). There were no differences in delirium, 30-day readmission or 30-day mortality. Conclusions Implementation of a model for early screening and multifactorial nonpharmacological interventions for patients with CI and delirium using quality improvement methodology may improve management of this patient group, increase staff awareness of family involvement, and reduce prescriptions of antipsychotics, hypnotics and sedatives. Trial registration: The protocol of this study was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System with the registration number: NCT04737733 and date of registration: 03/02/2021.

scholarly journals Overview of Traumatic Brain Injury Patients at a Tertiary Trauma Centre

2005 ◽  
Vol 32 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Elaine de Guise ◽  
Mitra Feyz ◽  
Joanne LeBlanc ◽  
Sylvain-Luc Richard ◽  
Julie Lamoureux
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
Scale Score ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Term Care ◽  
Traumatic Amnesia ◽  
Post Traumatic

ABSTRACT:Objective:The goal of this study was to provide a general descriptive and cognitive portrait of a population with traumatic brain injury (TBI) at the time of their acute care stay.Material and methods:Three hundred and forty-eight TBI patients were assessed. The following data were collected for each patient: age, level of education, duration of post-traumatic amnesia, Galveston Orientation Amnesia Test score, Glasgow Coma Scale score, results of cerebral imaging, Neurobehavioral Rating Scale score, the Functional Independence Measure cognitive score and the Glasgow Outcome Scale score.Results:The clinical profile of the population revealed a mean age of 40.2 (±18.7) and a mean of 11.5 (±3.6) years of education. Most patients presented with frontal (57.6%) and temporal (40%) lesions. Sixty-two percent had post-traumatic amnesia of less than 24 hours. Seventy percent presented with mild TBI, 14% with moderate and 15% with severe TBI. The cognitive deficits most frequently observed on the Neurobehavioral Rating Scale were in the areas of attention, memory and mental flexibility as well as slowness and mental fatigability. Most patients had good cognitive outcome on the Functional Independence Measure and scores of 2 and 3 were frequent on the GOS. Forty-five percent of the patients returned home after discharge, 51.7% were referred to in or out patient rehabilitation and 3.2% were transferred to long-term care facilities.Conclusion:Because of the specialized mandate of acute care institutions, the information provided here concerning characteristics of our TBI population is essential for more efficient decision-making and planning/programming with regards to care and service delivery.

scholarly journals A patient cohort on long-term sequelae of sepsis survivors: study protocol of the Mid-German Sepsis Cohort

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016827 ◽  
Author(s):  
André Scherag ◽  
Christiane S Hartog ◽  
Carolin Fleischmann ◽  
Dominique Ouart ◽  
Franziska Hoffmann ◽  
...  
Keyword(s):  
Acute Care ◽  
Primary Outcome ◽  
Functional Disability ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Number Of Patients ◽  
Sepsis Survivors

IntroductionAn increasing number of patients survive sepsis; however, we lack valid data on the long-term impact on morbidity from prospective observational studies. Therefore, we designed an observational cohort to quantify mid-term and long-term functional disabilities after intensive care unit (ICU)-treated sepsis. Ultimately, findings for the Mid-German Sepsis Cohort (MSC) will serve as basis for the implementation of follow-up structures for patients with sepsis and help to increase quality of care for sepsis survivors.Methods and analysisAll patients surviving ICU-treated sepsis are eligible and are recruited from five study centres in Germany (acute care hospital setting in Jena, Halle/Saale, Leipzig, Bad Berka, Erfurt; large long-term acute care hospital and rehabilitation setting in Klinik Bavaria Kreischa). Screening is performed by trained study nurses. Data are collected on ICU management of sepsis. On written informed consent provided by patients or proxies, follow-up is carried out by trained research staff at 3, 6 and 12 months and yearly thereafter. The primary outcome is functional disability as assessed by (instrumental) activities of daily living. Other outcomes cover domains like mortality, cognitive, emotional and physical impairment, and resource use. The estimated sample size of 3000 ICU survivors is calculated to allow detection of relevant changes in the primary outcome in sepsis survivors longitudinally.Ethics and disseminationThe study is conducted according to the current version of theDeclaration of Helsinkiand has been approved by four local/federal responsible institutional ethics committees and by the respective federal data protection commissioners. Results of MSC will be fed back to the patients and published in peer-reviewed journals.Trial registration numberGerman Clinical Trials Registry DRKS00010050.

scholarly journals MULTISENSORY STIMULATION FOR HOSPITALIZED PATIENTS WITH DEMENTIA: A PILOT STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S446-S446
Author(s):  
Sheila L Molony ◽  
Christine Waszynski
Keyword(s):  
Pilot Study ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Functional Independence Measure ◽  
Sensory Stimulation ◽  
Functional Independence ◽  
Hospitalized Patients ◽  
Mental Wellbeing ◽  
Care Hospital ◽  
Hospital Days

Abstract Introduction: Delirium occurs in up to 50% of hospitalized patients and the risk is higher in persons with dementia. Multi-sensory stimulation environments (MSSE), including trademarked “Snoezelen” rooms, have been effective in achieving positive outcomes in persons with dementia, but there have been no studies in the acute-care setting. Purpose: This pilot study tested the effect of a therapeutic Multi-sensory Stimulation Environment known as “the Hub” in an acute-care hospital. Methods: A sample of 56 patients were randomized to receive usual care or the Therapeutic Hub intervention during hospital days 2-4. Hub activities were multi-sensory and tailored based on preferences and abilities. We will describe techniques to address methodological challenges in the study with acutely ill, cognitively vulnerable participants. We will also present qualitative data describing the experience of participants receiving the Hub intervention, and will present preliminary findings regarding between group-differences in function (Functional Independence Measure), mobility, falls, wellbeing (Warwick-Edinburgh Mental Wellbeing Scale)– and person-environment relationship conceptualized as situational at-homeness (S-EOH). Conclusion: The results of this study will inform future trials on the effects of unique therapeutic environments for hospitalized persons at highest risk for delirium.

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