Meals beyond the bedside: An ethnographic exploration of staffs' perspectives and experiences of communal dining in subacute care

2021 ◽  
Author(s):  
Jessica Jong ◽  
Judi Porter ◽  
Claire Palermo ◽  
Ella Ottrey
Keyword(s):  
Subacute Care

A Multicenter Survey of Older Adults in Subacute Care on Their Current Driving Efficacy and Their Intention to Resume Driving After Discharge

2018 ◽  
Vol 26 (3) ◽  
pp. 21-25
Author(s):  
Sina Aghaie ◽  
Myriam Kline ◽  
Irina Dashkova ◽  
Karishma Patel ◽  
James Lolis ◽  
...  
Keyword(s):  
Older Adults ◽  
Subacute Care ◽  
Multicenter Survey

Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services

2018 ◽  
Vol 42 (4) ◽  
pp. 412 ◽  
Author(s):  
Julie Considine ◽  
Anastasia F. Hutchison ◽  
Helen Rawson ◽  
Alison M. Hutchinson ◽  
Tracey Bucknall ◽  
...  
Keyword(s):  
Patient Safety ◽  
Health Services ◽  
Medical Emergency Team ◽  
National Standards ◽  
Clinical Deterioration ◽  
Medical Emergency ◽  
Emergency Team ◽  
Subacute Care ◽  
Guidance Documents ◽  
Activation Criteria

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

Weaning Is Facilitated by Use of Non-fenestrated Tracheostomy Tubes in Chronically Ill Tracheostomized SubAcute Care Patient

CHEST Journal ◽  
2003 ◽  
Vol 124 (4) ◽  
pp. 205S
Author(s):  
Deepak K. Shrivastava ◽  
Sheela Kapre ◽  
Robert Gray
Keyword(s):  
Chronically Ill ◽  
Care Patient ◽  
Subacute Care ◽  
Tracheostomy Tubes

Mealtime interruptions, assistance and nutritional intake in subacute care

2016 ◽  
Vol 40 (4) ◽  
pp. 415 ◽  
Author(s):  
Judi Porter ◽  
Anita Wilton ◽  
Jorja Collins
Keyword(s):  
Systems Approach ◽  
Nutritional Intake ◽  
Energy Deficit ◽  
Observational Research ◽  
Subacute Care ◽  
Supportive Environment ◽  
Lengths Of Stay ◽  
Hospitalised Patients ◽  
Almost All ◽  
Mealtime Environment

Protected mealtimes is an initiative to support increased nutritional intake for all hospitalised patients, particularly those who are malnourished. The increased focus on maximising independence of patients in the subacute setting may provide a supportive environment for implementing these strategies. The aim of the present study was to gain insight into subacute ward practices at mealtimes under usual conditions (i.e. at baseline) where no protected mealtimes policy was implemented. Participants were patients aged ≥65 years recruited from subacute care facilities at a large healthcare network in Victoria, Australia. Participants were observed at mealtimes and mid meals (i.e. morning tea, afternoon tea and supper) to determine daily energy and protein intake, provision of mealtime assistance and mealtime interruptions. Almost all participants received assistance when it was needed, with positive and negative interruptions experienced by 56.2% and 76.2% of participants, respectively. There was an energy deficit of approximately 2 MJ per day between average intake and estimated requirements. In conclusion, mealtime practices were suboptimal, with particularly high rates of negative interruptions. Protected mealtimes is one strategy that may improve the mealtime environment to support patients’ dietary intake. Prospective studies are needed to evaluate its implementation and effects. What is known about this topic? The mealtime environment on a hospital ward may influence the nutritional intake of patients. Protected mealtimes is a systems approach that aims to minimise negative interruptions and promote positive interruptions to enhance the nutritional intake and nutritional status of patients. Whilst the approach has been widely implemented, further evaluation of its fidelity and effects is required. What does this paper add? This observational research has determined the nutritional intake, provision of assistance and interruptions at mealtimes experienced by a cohort of subacute care patients under usual care conditions. An energy deficit of approximately 2MJ below estimated requirements was identified. Half of the participants received positive interruptions and the majority of participants requiring assistance received it, however the prevalence of negative interruptions was high. This pilot study has enabled a fully powered prospective study to be designed, exploring the implementation of protected mealtimes and its effects on nutritional intake of patients in the subacute setting. What are the implications for practitioners? The energy deficit that exists for patients in subacute care may lead to nutritional decline, and longer lengths of stay. There are opportunities to improve ward practices at mealtimes in the subacute setting to focus on nutritional care.

Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study

2018 ◽  
Vol 77 ◽  
pp. 142-149 ◽  
Author(s):  
Den-Ching A. Lee ◽  
Cylie Williams ◽  
Aislinn F. Lalor ◽  
Ted Brown ◽  
Terry P. Haines
Keyword(s):  
Older Adults ◽  
Hospital Readmission ◽  
Subacute Care ◽  
Follow Up Study

Conversion from acute to subacute care beds

1995 ◽  
Vol 52 (10) ◽  
pp. 1042-1048
Author(s):  
Dennis W. Joubert
Keyword(s):  
Subacute Care

scholarly journals Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anthony Hecimovic ◽  
Vesna Matijasevic ◽  
Steven A. Frost
Keyword(s):  
Average Length ◽  
Hospital Setting ◽  
Local Health ◽  
The South ◽  
Subacute Care ◽  
Hospital At Home ◽  
Care Costs ◽  
Improve Patient ◽  
Drain Management ◽  
At Home

Abstract Background Hospital at home (HaH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HaH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HaH care across the South Western Sydney Local Health District (SWSLHD) has not been well described. This project aimed to describe the characteristics and outcomes of HaH services across the SWSLHD. Methods The characteristics of patients referred to HaH between January 2017 and December 2019, the indications for HaH, and representation rates to hospital emergency department (ED) will be presented. Results Between January 2017 and December 2019 there was 7118 referrals to the local health district’s (LHD) HaH services, among 6083 patients (3094 females, 51%), median age 56 years (Interquartile range (IQR), 40–69). The majority of indications for HaH were for intravenous venous (IV) medications (78%, n = 5552), followed by post-operative drain management (11%, n = 789), rehab in the home (RiTH) (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HaH only occurred on 172 (2%) of occasions. The average length of HaH treatment was 7-days (IQR 4–16). Rates of presentation to ED for HaH patients have decreased since 2017, 3.4% (95% CI 2.7–4.2%), 2018 2.1% (95% CI 1.5–2.8%), and 2019 1.8% (95% CI 1.3–2.4%), p-value for trend < 0.001. Conclusion Hospital at Home is well established, diverse, and safe clinical service to shorten, or avoid hospitalisation, for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.

Direct Admission from the Emergency Department to a Subacute Care Ward: An Alternative to Acute Hospitalization

2020 ◽  
Vol 21 (9) ◽  
pp. 1346-1348
Author(s):  
Seng Hock Ang ◽  
Barbara Helen Rosario ◽  
Ko Yen Ivan Ngeow ◽  
Xin Yu Koh ◽  
Seruwati Abdul Hamid ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Hospitalization ◽  
Subacute Care ◽  
Direct Admission ◽  
Care Ward

scholarly journals Subacute care funding in the firing line

2013 ◽  
Vol 199 (2) ◽  
pp. 92-93 ◽  
Author(s):  
Christopher J Poulos ◽  
Kathy Eagar ◽  
Steven G Faux ◽  
John J Estell ◽  
Maria Crotty
Keyword(s):  
Subacute Care ◽  
Firing Line
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