The “Permanent” Patient Problem

2014 ◽  
Vol 42 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Courtenay R. Bruce ◽  
Mary A. Majumder
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Acute Care ◽  
Affordable Care Act ◽  
Financial Incentive ◽  
Legal Obligation ◽  
Medicaid Enrollment ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. The care of these patients contributes to the rising costs of health care and will remain largely unaffected by the Affordable Care Act. For example, some resources may be available for treatment of undocumented persons, but Medicaid enrollment is unavailable for this population. Even where patients have access to Medicaid, it takes up to three months between applying for and actually receiving Medicaid benefits. During that time, patients may be ready for hospital discharge. However, post-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage.

Factors Associated With Early Readmission Among Patients Discharged to Post-Acute Care Facilities

2017 ◽  
Vol 65 (6) ◽  
pp. 1199-1205 ◽  
Author(s):  
Carolyn Horney ◽  
Roberta Capp ◽  
Rebecca Boxer ◽  
Robert E. Burke
Keyword(s):  
Acute Care ◽  
Factors Associated ◽  
Care Facilities ◽  
Early Readmission ◽  
Acute Care Facilities ◽  
Post Acute Care

Pre-operative Predictors for Discharge to Post-Acute Care Facilities After Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chan Zeng ◽  
Ryan Koonce ◽  
Heather M. Tavel ◽  
Suzanne Espiritu Argosino ◽  
Denise A. Kiepe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Acute Care ◽  
Knee Arthroplasty ◽  
Care Facilities ◽  
Total Knee ◽  
Acute Care Facilities ◽  
Post Acute Care

scholarly journals ECHO-CT: An Interdisciplinary Videoconference Model for Identifying Potential Postdischarge Transition-of-Care Events

2021 ◽  
Vol 16 (2) ◽  
pp. 93-96
Author(s):  
Mariana R Gonzalez ◽  
Lauren Junge-Maughan ◽  
Lewis A Lipsitz ◽  
Amber Moore
Keyword(s):  
Acute Care ◽  
Care Transitions ◽  
Transition Of Care ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Surgical Services ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

BACKGROUND: Discharge from the hospital to a post–acute care setting can be complex and potentially dangerous, with opportunities for errors and lapses in communication between providers. Data collected through the Extension for Community Health Outcomes–Care Transitions (ECHO-CT) model were used to identify and classify transition-of-care events (TCEs). METHODS: The ECHO-CT model employs multidisciplinary videoconferences between a hospital-based team and providers in post–acute care settings; during these conferences, concerns regarding the patient’s care transition were identified and recorded. The videoconferences took place from January 2016 to October 2018 and included patients discharged from inpatient medical and surgical services to a total of eight participating post–acute care facilities (skilled nursing facilities or long-term acute care hospitals). RESULTS: During the interdisciplinary videoconferences in this period, 675 patients were discussed. A total of 139 TCEs were identified; 58 (41.7%) involved discharge communication or coordination errors and 52 (37.4%) were classified as medication issues. CONCLUSION: The TCEs identified in this study highlight areas in which providers can work to reduce issues arising during the course of discharge to post–acute care facilities. Standardized processes to identify, record, and report TCEs are necessary to provide high-quality, safe care for patients as they move across care settings.

scholarly journals Antimicrobial stewardship in pediatric post-acute care facilities

2018 ◽  
Vol 46 (4) ◽  
pp. 468-470 ◽  
Author(s):  
Candace L. Johnson ◽  
Meaghan Jain ◽  
Lisa Saiman ◽  
Natalie Neu
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

scholarly journals Regional spread of blaNDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

2021 ◽  
Author(s):  
Zena Lapp ◽  
Ryan Crawford ◽  
Arianna Miles-Jay ◽  
Ali Pirani ◽  
William E Trick ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Patient Transfer ◽  
Point Prevalence ◽  
Care Hospital ◽  
Chicago Area ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

Background Carbapenem-resistant Enterobacterales (CRE) harboring blaKPC have been endemic in Chicago-area healthcare networks for more than a decade. During 2016-2019, a series of regional point prevalence surveys identified increasing prevalence of blaNDM-containing CRE in multiple long-term acute care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). We performed a genomic epidemiology investigation of blaNDM-producing CRE to understand their regional emergence and spread. Methods We performed whole-genome sequencing on NDM+ CRE isolates from four point-prevalence surveys across 35 facilities (LTACHs, vSNFs, and acute care hospital medical intensive care units) in the Chicago area and investigated the genomic relatedness and transmission dynamics of these isolates over time. Results Genomic analyses revealed that the rise of NDM+ CRE was due to the clonal dissemination of an ST147 Klebsiella pneumoniae strain harboring blaNDM-1 on an IncF plasmid. Dated phylogenetic reconstructions indicated that ST147 was introduced into the region around 2013 and likely acquired NDM around 2015. Analyzing genomic data in the context of patient transfer networks supported initial increases in prevalence due to intra-facility transmission in certain vSNFs, with evidence of subsequent inter-facility spread to connected LTACHs and vSNFs via patient transfer. Conclusions We identified a regional outbreak of blaNDM-1 ST147 that began in and disseminated across Chicago area post-acute care facilities. Our findings highlight the importance of performing genomic surveillance at post-acute care facilities to identify emerging threats.

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