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.

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.

scholarly journals Post-Acute Care Service use in Lung Cancer Patients

2021 ◽  
Author(s):  
Mitra McLarney ◽  
Frances S. Shofer ◽  
Jasmine Zheng
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Acute Care ◽  
Service Use ◽  
Care Service ◽  
Rehabilitation Service ◽  
Lung Cancer Patients ◽  
Acute Care Service ◽  
Post Acute Care

Abstract Purpose: Lung cancer patients experience functional deconditioning secondary to their underlying cancer and treatment yet rehabilitation service use remains low. The goal of this study is to compare post-acute care service use in lung cancer patients admitted to a metropolitan academic medical center. Methods: Adult lung cancer patients admitted from January 1, 2017 to August 31, 2018 with a diagnosis of lung cancer based on International Classification of Diseases 10, C34.0-C34.9, were included in this study. Patient characteristics including age, gender, race, marital status, functional status on admission, length of stay, and number of comorbidities were compared based on discharge setting. Results: 1,139 lung cancer patients were included in our study. The majority of patients discharged home with home care (51%) followed by home without services (35%), skilled nursing facilities (SNF) (10%) and acute inpatient rehabilitation facilities (IRF) (4%). 44% (498) of patients were primarily admitted for their lung cancer diagnosis. In unadjusted analyses, patients who discharged to SNF compared to home were more likely to be older, black, unmarried, live alone and have died during the study period. Patients who discharged to IRF had longer acute care hospitalization length of stays. In adjusted analyses, age, number of concurrent comorbidities and length of stay significantly correlated with discharge location. Conclusion: Lung cancer patients are unlikely to be discharged to a post-acute care facility after an acute hospitalization. Rehabilitation service use differs by sociodemographic factors, concurrent medical history and functional status. Future study is needed to better understand why these differences in discharge setting persists.

scholarly journals Association of the FRAIL scale with rehabilitation outcomes in the community hospital setting

2021 ◽  
Author(s):  
J Jiang ◽  
YYA Han ◽  
J Goh
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Community Hospital ◽  
Hospital Setting ◽  
Frailty Status ◽  
Rehabilitation Outcomes ◽  
Adverse Health Outcomes ◽  
Frail Patients ◽  
Functional Gain ◽  
Post Acute Care

Introduction: Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale. In Singapore, its use has been studied in tertiary hospitals but not in community hospitals. A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources. We aimed to determine whether the FRAIL scale is associated with rehabilitation outcomes in patients admitted to the community hospital setting, where post-acute care and rehabilitation are primarily delivered. Methods: This was a retrospective cohort study. The FRAIL scale was utilised to screen 560 older adults who were admitted to a community hospital for rehabilitation. Data were analysed to determine the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay and discharge destination. Results: The combined score of the FRAIL scale showed significant negative association with absolute functional gain (p < 0.001), rehabilitation effectiveness (p < 0.001) and rehabilitation efficiency (p < 0.001), whereas it was positively associated with increased length of stay (p < 0.05) and a need for continued support in increased care settings (p < 0.001). Individual components of the FRAIL scale, in particular, the ‘fatigue’, ‘ambulation’ and ‘loss of weight’ components, appeared to be highly associated with rehabilitation effectiveness and efficiency, especially among pre-frail patients. Conclusion: The utility of the FRAIL scale as an indicator of frailty status and its association with rehabilitative outcomes in the post-acute care setting were demonstrated. Moreover, the FRAIL scale may better predict the rehabilitative progress of pre-frail patients.

scholarly journals Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie

2018 ◽  
Vol 5 (1) ◽  
pp. 25-34
Author(s):  
Antoinette Conca ◽  
Doaa Ebrahim ◽  
Sandra Noack ◽  
Angela Gabele ◽  
Helen Weber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Social Workers ◽  
Acute Care ◽  
Discharge Planning ◽  
Control Period ◽  
Stepped Wedge ◽  
Intervention Period ◽  
Care Needs ◽  
Cluster Randomized ◽  
Post Acute Care

AbstractBackgroundElderly patients often need post-acute care after hospital discharge. Involvement of social workers can positively affect the discharge planning process.AimTo investigate the effect of screening patients at risk for post-acute care needs by social workers on time with respect to social workers’ notification, length of stay and delays in discharge compared to usual care.MethodsCluster randomized stepped wedge trial design for five clusters (wards) and two steps (control to intervention) was used. A total of 400 patients (200 per period) with high risk of post-acute care needs (defined as Post-Acute Care Discharge score, PACD ≥ 7) were included. Social workers performed a screening to decide about self-referral to their services (intervention period), which was compared to a highly structured standard SW notification by physicians and nurses (control period). A Generalized Estimating Equations model adjusted the clustering and baseline differences.ResultsA total of 139 patients were referred to social services (intervention: n = 76; control: n = 63). Time to social workers’ notification was significantly shorter in the intervention period when adjusted for all the differences in baseline (Mdn 1.2 vs 1.7, Beta = -0.73, 95%-CI 1.39 to -0.09). Both the length of stay and the delayed discharge time in nights showed no significant differences (Mdn 10.0 vs 9.1, Beta = -0.12, 95%-CI 0.46 to .22 nights 95%-CI, resp. Mdn 0.0 vs 0.0, Beta = .11, 95%-CI -0.64 to 0.86).ConclusionScreening speeded up social workers’ notification but did not accelerate the discharge processes. The screening by social workers might show process improvement in settings with less structured discharge planning.

scholarly journals 88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Edel McDaid ◽  
Elaine Ross ◽  
Lisa Cogan
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Long Term Care ◽  
Discharge Destination ◽  
Clinical Frailty Scale ◽  
Geriatric Population ◽  
Term Care ◽  
Geriatric Unit ◽  
Post Acute Care

Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.

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