The Impact of Introducing a Physical Medicine and Rehabilitation Consultation Service to an Academic Burn Center

2019 ◽  
Vol 40 (5) ◽  
pp. 648-651
Author(s):  
Lawrence R Robinson ◽  
Matthew Godleski ◽  
Sarah Rehou ◽  
Marc Jeschke
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Trauma Patients ◽  
Physical Medicine ◽  
Consultation Service ◽  
Physical Medicine And Rehabilitation ◽  
The Impact

Abstract Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS.

scholarly journals Academic Physical Medicine and Rehabilitation Acute Care Consultations

2018 ◽  
Vol 45 (4) ◽  
pp. 470-473
Author(s):  
Shannon L. MacDonald ◽  
Lawrence R. Robinson
Keyword(s):  
United States ◽  
Acute Care ◽  
Department Chairs ◽  
The United States ◽  
Physical Medicine ◽  
Consultation Service ◽  
Physical Medicine And Rehabilitation ◽  
National Differences ◽  
Care Consultation ◽  
American Academic

AbstractThe objective of this study was to describe the provision of Physical Medicine and Rehabilitation acute care consultations in the United States and Canada. Physical Medicine and Rehabilitation department chairs/division directors at academic centers in Canada and the United States were mailed an 18-item questionnaire. Seven of 13 (54%) Canadian and 26/78 (33%) American surveys were returned. A majority of Canadian and American academic institutions provide acute care consultations; however, there were some national differences. American institutions see larger volumes of patients, and more American respondents indicated using a dedicated acute care consultation service model compared with Canadians.

Impact of Acute Care General Surgery Coverage by Trauma Surgeons on the Trauma Patient

2008 ◽  
Vol 74 (6) ◽  
pp. 494-502 ◽  
Author(s):  
Paul J. Schenarts ◽  
Sachin V. Phade ◽  
Claudia E. Goettler ◽  
Brett H. Waibel ◽  
Steven C. Agle ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Patient ◽  
Acute Care ◽  
General Surgery ◽  
Injury Severity ◽  
Trauma Patients ◽  
Trauma Service ◽  
Severity Scores ◽  
Trauma Surgeons ◽  
The Impact

Although acute care general surgery (ACS) coverage by trauma surgeons may help re-invigorate the field of trauma surgery, introducing additional responsibilities to an already overburdened system may negatively impact the trauma patient. Our purpose was to determine the impact on the trauma patient of a progressive integration of ACS coverage into a trauma service. Data from a university, Level I trauma registry was retrospectively reviewed to compare demographics, injury severity, complications, and outcomes over a 6-year period. During this study period, the trauma service treated only trauma patients for 32 months, then added ACS coverage 2 days per week for 32 months, and then expanded to 4 days per week coverage for 9 months. Trauma patients admitted during periods of ACS coverage were not different with respect to gender, mechanism of injury, Revised Trauma Score, or Glasgow Coma Score; however, they were slightly older and had slightly higher injury severity scores. As ACS coverage progressively increased, trauma patients had an increase in ventilator days ( P < 0.0001), intensive care unit length of stay ( P < 0.0001), and hospital length of stay ( P < 0.0001). Occurrences of neurologic, pulmonary, gastrointestinal, and infectious complications were similar during all three time periods, whereas cardiac and renal complications progressively increased after ACS coverage was added. Mortality remained unchanged after ACS integration.

scholarly journals Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury

2015 ◽  
Vol 30 (5) ◽  
pp. 451-460 ◽  
Author(s):  
Peii Chen ◽  
Irene Ward ◽  
Ummais Khan ◽  
Yan Liu ◽  
Kimberly Hreha
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Current Knowledge ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Spatial Neglect ◽  
Future Research ◽  
Discharge Disposition ◽  
The Impact

Background. Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective. To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods. The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results. In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury–induced mass effect predicted left-sided neglect. Conclusions. Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

2021 ◽  
pp. 1-19
Author(s):  
Jonathan Plante ◽  
Karine Latulippe ◽  
Edeltraut Kröger ◽  
Dominique Giroux ◽  
Martine Marcotte ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Length Of Stay ◽  
Acute Care ◽  
Scoping Review ◽  
Research Question ◽  
Positive Association ◽  
Well Being ◽  
Future Research ◽  
Care Hospital ◽  
The Impact

Abstract Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

2001 ◽  
Vol 10 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Jan Coleman Gross ◽  
Stacey W. Goodrich ◽  
Mary E. Kain ◽  
Elizabeth A. Faulkner
Keyword(s):  
Nursing Care ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Two Factors ◽  
Staffing Needs ◽  
Care Index ◽  
Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

2018 ◽  
Vol 53 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Mary-Haston Leary ◽  
Kathryn Morbitzer ◽  
Bobbi Jo Walston ◽  
Stephen Clark ◽  
Jenna Kaplan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Positive Impact ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Readmission Rates ◽  
A Value ◽  
Pharmacist Interventions ◽  
Semistructured Interviews ◽  
The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

scholarly journals The Impact of Selenium Supplementation on Trauma Patients—Systematic Review and Meta-Analysis

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 342
Author(s):  
Jen-Fu Huang ◽  
Chih-Po Hsu ◽  
Chun-Hsiang Ouyang ◽  
Chi-Tung Cheng ◽  
Chia-Cheng Wang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Current Evidence ◽  
Trauma Patients ◽  
Positive Effects ◽  
Standard Difference ◽  
The Impact

This study aimed to assess current evidence regarding the effect of selenium (Se) supplementation on the prognosis in patients sustaining trauma. MEDLINE, Embase, and Web of Science databases were searched with the following terms: “trace element”, “selenium”, “copper”, “zinc”, “injury”, and “trauma”. Seven studies were included in the meta-analysis. The pooled results showed that Se supplementation was associated with a lower mortality rate (OR 0.733, 95% CI: 0.586, 0.918, p = 0.007; heterogeneity, I2 = 0%). Regarding the incidence of infectious complications, there was no statistically significant benefit after analyzing the four studies (OR 0.942, 95% CI: 0.695, 1.277, p = 0.702; heterogeneity, I2 = 14.343%). The patients with Se supplementation had a reduced ICU length of stay (standard difference in means (SMD): −0.324, 95% CI: −0.382, −0.265, p < 0.001; heterogeneity, I2 = 0%) and lesser hospital length of stay (SMD: −0.243, 95% CI: −0.474, −0.012, p < 0.001; heterogeneity, I2 = 45.496%). Se supplementation after trauma confers positive effects in decreasing the mortality and length of ICU and hospital stay.

Abstract WP356: Unbundling Care Transitions and Cost After Stroke: Results From the BPCI-Advanced Program

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Geri Sanfillippo ◽  
Brian Olkowski ◽  
Hermann Christian Schumacher ◽  
David Dafilou ◽  
Colleen Bowski ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Utilization ◽  
Care Coordination ◽  
Program Implementation ◽  
Care Transitions ◽  
Inpatient Rehabilitation ◽  
Hospital Length Of Stay ◽  
Early Supported Discharge ◽  
The Impact ◽  
Post Acute Care

Introduction: The Centers for Medicare and Medicaid Services bundled payment for care improvement advanced (BPCI-A) program incentivizes providers to better coordinate care, reduce expenses, and improve quality. The purpose of this study was to determine the impact of improving post-acute care coordination after stroke on quality and resource utilization in the BPCI-A program. Methods: Capital Health collaborated with post-acute providers to improve communication, identify criteria for early supported discharge to the community, expedite home health and outpatient services, reduce readmissions, and initiate advanced care planning. The redesigned post-acute care coordination program was implemented at Capital Health’s primary and comprehensive stroke center. Quality outcomes and resource utilization measures for patients enrolled in the BCPI-A program were compared to BPCI-A eligible patients prior to program implementation. Results: Forty-three patients enrolled in the BCPI-A program were compared to 77 patients eligible for enrollment. Clinical and demographic characteristics were similar (p>.05). After program implementation, 21.5% fewer patients were discharged to an inpatient rehabilitation facility (p=.024) and 14% more patients were discharged to inpatient hospice (p<.001). On average, post-acute cost decreased $16,608 per patient (p=.007) resulting in a $16,820 reduction in the 90-day cost per episode (p=.011). The 90-day hospital readmission rate decreased insignificantly by 14.1% from 23.4% to 9.3% (p=.056). Hospital cost, hospital length of stay and the 90-day mortality rate were unchanged (p>.05). Conclusion: The coordination of post-acute services facilitates care transitions after stroke. The identification of patients meeting criteria for early supported discharge to the community or admission to inpatient hospice helped reduce post-acute cost without increasing 90-day readmission or mortality.

Impact of Length of Stay on Functional Outcomes of TBI Patients

2005 ◽  
Vol 71 (11) ◽  
pp. 920-930 ◽  
Author(s):  
M.L. Hawkins ◽  
F.D. Lewis ◽  
R.S. Medeiros
Keyword(s):  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Care ◽  
Average Length ◽  
Functional Independence ◽  
Average Length Of Stay ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

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