2480. Communication During Patient Transfers: Describing Gaps in the Infectious Status Information Pipeline

Abstract Background Fragmented communication of patients’ infectious status across healthcare networks impact regional spread of multidrug-resistant organisms (MDRO). This study aimed to quantify gaps in communication of patient MDRO status across Utah healthcare facilities and to identify opportunities to improve. Methods This is a cross-sectional retrospective mixed-methods study of patient transfers from three purposively selected healthcare facilities: an acute care (ACF), long-term acute care (LTAC), and skilled-nursing facility (SNF). Patients with known MDRO transferred out of these facilities over the previous week were identified in bimonthly samples spanning 2 months. Infection preventionists and admission nurses from facilities receiving these patients were interviewed. Results Of 293 patients transferred to another facility, 13% (n = 38) had an active infection or colonization with an MDRO. These 38 patients were transferred to 26 healthcare facilities within the state (4 ACF, 3 LTAC, 19 SNF). Gram-negative organisms with resistance to a carbapenem accounted for 15.8% of those transferred with an MDRO. There was no documentation of the state infection control transfer form (ICTF) at the sending facility for 68.5% of MDRO patient transfers. Of 22 admitting nurses interviewed, 19 (86.4%) did not receive an ICTF, 6 (27.3%) received no communication regarding patients’ infectious status, and 11 (50%) had to contact the sending facility for additional information. Moreover, 18.2% of patients had not been put on appropriate precautions. Several nurses expressed confusion with MDRO definitions and lack of guidance regarding care of MDRO colonized patients. Among infection preventionists asked about general MDRO transfers (n = 26), 26.9% reported that communication on infectious status of MDRO patients was received in under 40% of incoming transfers. When asked about a planned statewide MDRO registry, 80.8% felt that such a system would be actively searched at their facility, and 96.2% felt that a system that pushes out alerts would be useful. Conclusion Given the widespread gaps in communication of infectious status of patients with MDROs transferred across the healthcare facilities sampled, efforts to standardize and improve MDRO communication in the region is warranted. Disclosures All authors: No reported disclosures.

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Where Skilled Nursing Facility Residents Get Acute Care: Is the Emergency Department the Medical Home?

Journal of Applied Gerontology ◽

10.1177/0733464820950125 ◽

2020 ◽

pp. 073346482095012

Author(s):

Arjun K. Venkatesh ◽

Cameron J. Gettel ◽

Hao Mei ◽

Shih-Chuan Chou ◽

Craig Rothenberg ◽

...

Keyword(s):

Acute Care ◽

Skilled Nursing Facility ◽

Community Setting ◽

Transitions Of Care ◽

Medicare Beneficiaries ◽

Cross Sectional ◽

Nursing Facility ◽

Data Set ◽

Skilled Nursing ◽

Sectional Analysis

Objectives: This study aimed to characterize the distribution of acute care visits among Medicare beneficiaries receiving skilled nursing facility (SNF) services. Methods: We conducted a cross-sectional analysis of a 20% sample of continuously enrolled Medicare beneficiaries in the 2012 Chronic Condition Warehouse data set. Beneficiaries were grouped by the number of days of SNF services, and acute care visits were categorized as “before SNF,” “during SNF,” or “after SNF.” Results: Among the 10,717,786 Medicare beneficiaries analyzed, 384,312 (3.6%) had at least one SNF stay. Discussion: Beneficiaries who received SNF services had a higher proportion of acute care visits made to emergency departments (EDs) than beneficiaries who did not receive SNF services. Also, a higher proportion of acute care visits were made to EDs by beneficiaries after a SNF stay in comparison to residents actively residing in a SNF. The acute care capabilities of SNFs and post-SNF transitions of care to the community setting are discussed.

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Assessing the Burden ofAcinetobacter baumanniiin Maryland: A Statewide Cross-Sectional Period Prevalence Survey

Infection Control and Hospital Epidemiology ◽

10.1086/667376 ◽

2012 ◽

Vol 33 (9) ◽

pp. 883-888 ◽

Cited By ~ 8

Author(s):

Kerri A. Thorn ◽

Lisa L. Maragakis ◽

Katie Richards ◽

J. Kristie Johnson ◽

Brenda Roup ◽

...

Keyword(s):

Acute Care ◽

Multidrug Resistant ◽

Prevalence Survey ◽

Cross Sectional ◽

Term Care ◽

Healthcare Facilities ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Surveillance Cultures ◽

Ventilated Patients

Objective.To determine the prevalence ofAcinetobacter baumannii, an important healthcare-associated pathogen, among mechanically ventilated patients in Maryland.Design.The Maryland MDRO Prevention Collaborative performed a statewide cross-sectional active surveillance survey of mechanically ventilated patients residing in acute care and long-term care (LTC) facilities. Surveillance cultures (sputum and perianal) were obtained from all mechanically ventilated inpatients at participating facilities during a 2-week period.Setting.All healthcare facilities in Maryland that provide care for mechanically ventilated patients were invited to participate.Patients.Mechanically ventilated patients, known to be at high risk for colonization and infection withA. baumannii, were included.Results.Seventy percent (40/57) of all eligible healthcare facilities participated in the survey, representing both acute care (n= 30) and LTC (n= 10) facilities in all geographic regions of Maryland. Surveillance cultures were obtained from 92% (358/390) of eligible Patients.A. baumanniiwas identified in 34% of all mechanically ventilated patients in Maryland; multidrug-resistantA. baumanniiwas found in 27% of all Patients.A. baumanniiwas detected in at least 1 patient in 49% of participating facilities; 100% of LTC facilities had at least 1 patient with A.baumannii, compared with 31% of acute care facilities.A. baumanniiwas identified from all facilities in which 10 or more patients were sampled.Conclusions.A.baumanniiis common among mechanically ventilated patients in both acute care and LTC facilities throughout Maryland, with a high proportion of isolates demonstrating multidrug resistance.

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Characteristics Associated with the Use of an Inpatient Rehabilitation or Skilled Nursing Facility after Acute Care in Children with Severe Traumatic Brain Injury

Developmental Neurorehabilitation ◽

10.1080/17518423.2021.1908441 ◽

2021 ◽

pp. 1-12

Author(s):

Shiyao Gao ◽

Anthony Fabio ◽

Bedda L. Rosario ◽

M. Kathleen Kelly ◽

Sue R. Beers ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Acute Care ◽

Severe Traumatic Brain Injury ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Nursing Facility ◽

Skilled Nursing

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Termination of Skilled Nursing Facility Medicaid Provider Agreements: Procedural Due Process Requirements

American Journal of Law & Medicine ◽

10.1017/s0098858800005980 ◽

1981 ◽

Vol 6 (4) ◽

pp. 451-493

Author(s):

Nancy Elizabeth Jones

Keyword(s):

Due Process ◽

Skilled Nursing Facility ◽

Health And Safety ◽

The State ◽

Federal Regulations ◽

Nursing Facility ◽

Skilled Nursing ◽

Medicaid Reimbursement ◽

Emergency Situations ◽

Procedural Due Process

AbstractWhen a state Medicaid agency terminates its provider agreement with a skilled nursing facility, federal regulations give the state the option of providing a pretermination evidentiary hearing; they do not, however, require that a state provide such a hearing. If a state chooses not to grant a pretermination hearing, as a number of states have done, federal regulations require: (1) an informal written reconsideration made by the state and submitted to the skilled nursing facility before the effective date of the termination, and (2) a posttermination evidentiary hearing.This Article argues that a skilled nursing facility has a right under the due process clauses of the fifth and fourteenth amendments of the U. S. Constitution to an evidentiary hearing before termination of its Medicaid provider agreement. The author claims that a skilled nursing facility's interest in continued receipt of Medicaid reimbursement under its provider agreement is a property interest entitled to constitutional due process protections, and not merely an expectation of economic benefit that does not implicate constitutional due process considerations.The Article concludes that, except in emergency situations, state Medicaid agencies are constitutionally required to grant a provider a pretermination, rather than a posttermination, evidentiary hearing. This procedure would protect the provider and its patients from the severe effects of an erroneous termination, while furthering the governmental interest in ensuring the health and safety of skilled nursing facility patients. The format for such a hearing should allow for the participation, with the assistance of counsel, of both the skilled nursing facility and its patients.

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Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.131 ◽

2021 ◽

pp. 1-6

Author(s):

Katherine D. Ellingson ◽

Brie N. Noble ◽

Genevieve L. Buser ◽

Graham M. Snyder ◽

Jessina C. McGregor ◽

...

Keyword(s):

Acute Care ◽

Infection Prevention ◽

Multidrug Resistant ◽

Research Network ◽

Resistant Organism ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Hospital Size ◽

Academic Affiliation ◽

Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

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Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

Frontiers in Medicine ◽

10.3389/fmed.2021.750650 ◽

2021 ◽

Vol 8 ◽

Author(s):

Vivek Nimgaonkar ◽

Jeffrey C. Thompson ◽

Lauren Pantalone ◽

Tessa Cook ◽

Despina Kontos ◽

...

Keyword(s):

Racial Disparities ◽

Acute Care ◽

Odds Ratio ◽

Skilled Nursing Facility ◽

Index Admission ◽

Composite Outcome ◽

Nursing Facility ◽

Skilled Nursing ◽

Black Patients ◽

Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

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Prevalence and Trend in the Use of Hospital-Based Standing Orders Programs for Influenza and Pneumococcal Vaccination

Infection Control and Hospital Epidemiology ◽

10.1086/519208 ◽

2007 ◽

Vol 28 (8) ◽

pp. 899-904 ◽

Cited By ~ 1

Author(s):

Sri Ram Pentakota ◽

William Halperin

Keyword(s):

New Jersey ◽

Influenza Vaccination ◽

Acute Care ◽

State Government ◽

Pneumococcal Vaccination ◽

Acute Care Hospitals ◽

Health Department ◽

The State ◽

Healthcare Facilities ◽

Hospital Characteristics

Background.In 2002, federal regulations authorized the use of standing orders programs (SOPs) for promoting influenza and pneumococcal vaccination. In 2003, the New Jersey Hospital Association conducted a demonstration project illustrating the efficacy of SOPs, and the state health department informed healthcare facilities of their benefits. We describe the prevalence of reported use of SOPs in New Jersey hospitals in 2003 and 2005 and identify hospital characteristics associated with the use of SOPs.Methods.A survey was mailed to the directors of infection control at 117 New Jersey hospitals during the period from January to May 2005 (response rate, 90.6%). Data on hospital characteristics were obtained from hospital directories and online resources.Results.The prevalence of use of SOPs for influenza vaccination was 50% (95% confidence interval [CI], 40.1%-59.9%) in 2003, and it increased to 78.3% (95% CI, 69.2%-85.7%) in 2005. The prevalence of SOP use for pneumococcal vaccination was similar. In 2005, the reported rate of use of SOPs for inpatients (influenza vaccination, 76.4%; pneumococcal vaccination, 75.5%) was significantly higher than that for outpatients (influenza vaccination, 9.4%; pneumococcal vaccination, 8.5%). Prevalence ratios for SOP use comparing acute care and non-acute care hospitals were 1.71 (95% CI, 1.2-2.5) for influenza vaccination SOPs and 1.8 for (95% CI, 1.2-2.7) pneumococcal vaccination SOPs. Acute care hospitals with a ratio of admissions to total beds greater than 36.7 reported greater use of SOPs for pneumococcal vaccination, compared with those that had a ratio of less than 36.7.Conclusion.The increase in the prevalence of reported use of SOPs among New Jersey hospitals in 2005, compared with 2003, was contemporaneous with SOP-related actions taken by the federal government, the state government, and the New Jersey Hospital Association. Opportunities persist for increased use of SOPs among non-acute care hospitals and for outpatients.

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Implementing INTERACT (Intervention to Reduce Avoidable Acute Care Transfer) Distance Learning Curriculum to Reduce Avoidable Acute Care Transfer and Improve the Quality of Care in a Skilled Nursing Facility

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2011.12.006 ◽

2012 ◽

Vol 13 (3) ◽

pp. B15

Author(s):

Yangping Ye ◽

Alethea Phippis ◽

Sharla Reiman ◽

Debra Carr ◽

...

Keyword(s):

Quality Of Care ◽

Distance Learning ◽

Acute Care ◽

Skilled Nursing Facility ◽

Nursing Facility ◽

Skilled Nursing ◽

Transfer Distance ◽

Care Transfer

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Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7534 ◽

2020 ◽

Vol 18 (7) ◽

pp. 856-865

Author(s):

Sarguni Singh ◽

Megan Eguchi ◽

Sung-Joon Min ◽

Stacy Fischer

Keyword(s):

Acute Care ◽

Skilled Nursing Facility ◽

Home Healthcare ◽

Categorical Variables ◽

Nursing Facility ◽

Skilled Nursing ◽

Patients With Cancer ◽

Patient Goals ◽

Patient Groups ◽

To Receive

Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.

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