Understanding Acute Care Usage by Adult Chronically Critically Ill Ventilated Patients: A Chart Review

2020 ◽  
Vol 14 (3) ◽  
pp. 123-129
Author(s):  
Sarah Crowe ◽  
A. Fuchsia Howard ◽  
Gregory Haljan
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Acute Care ◽  
Residential Care ◽  
Long Term Care ◽  
Emergency Department Visits ◽  
Term Care ◽  
Residential Care Facility ◽  
Chronically Critically Ill

ObjectivesTo better understand the rationale for acute care usage among long term care ventilated residents.BackgroundChronically critically ill ventilated individuals experience complex health challenges, with many not surviving one year post initial hospitalization discharge. Recent research reports high acute care readmission rates for chronically critically ill patients, yet most studies have not examined the reasons patients are readmitted, nor the treatment and care provided during these stays.MethodA retrospective medical chart reviews of all emergency department visits and acute care admissions, occurring from August 2014 to August 2016, of chronically critically ill ventilated individuals living in a residential care facility in the province of British Columbia, Canada was conducted.ResultsThere were 49 emergency department visits and 56 acute care admissions over a 2 year period by 20 chronically critically ill ventilated residential care patients. The majority of acute care admissions were related to pneumonia, whereas the majority of emergency department visits were not specified.ConclusionChronically critically ill ventilated long term care residents are high users of acute care resources, frequently admitted for pneumonia.

scholarly journals 1442. Effect of Reflex Urine Culturing on Rates of Cultures and Infections in an Acute Care Hospital, Emergency Department, and Two Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S526-S526
Author(s):  
Chelsea Lynch ◽  
Andrea Appleby-Sigler ◽  
Jacqueline Bork ◽  
Rohini Dave ◽  
Kimberly C Claeys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Long Term Care ◽  
White Blood Cells ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Post Intervention ◽  
Term Care ◽  
Absolute Increase

Abstract Background Urine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown. Methods This was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented. Results In acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs. Conclusion Reflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.

scholarly journals Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents

2016 ◽  
Vol 29 (2) ◽  
pp. 201-208 ◽  
Author(s):  
E. G. Marshall ◽  
B. Clarke ◽  
F. Burge ◽  
N. Varatharasan ◽  
G. Archibald ◽  
...  
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Long Term Care ◽  
Emergency Department Visits ◽  
Term Care

Frequency and Pattern of Emergency Department Visits by Long-Term Care Residents-A Population-Based Study

2010 ◽  
Vol 58 (3) ◽  
pp. 510-517 ◽  
Author(s):  
Andrea Gruneir ◽  
Chaim M. Bell ◽  
Susan E. Bronskill ◽  
Michael Schull ◽  
Geoffrey M. Anderson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Long Term Care ◽  
Population Based ◽  
Emergency Department Visits ◽  
Term Care ◽  
Population Based Study

scholarly journals Access to palliative care in Canada

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Tracy Johnson ◽  
Clare Cheng ◽  
Christina Lawand ◽  
Maureen Kelly
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Home Care ◽  
Health System ◽  
Acute Care ◽  
Long Term Care ◽  
Emergency Department Visits ◽  
Data Availability ◽  
Term Care

IntroductionMany Canadians prefer to remain in the community at end-of-life, and to die at home. To do so, early and integrated palliative care (PC) is needed to provide individuals with care and support services across care settings. Measuring access to PC can help to evaluate progress over time. Objectives and ApproachThis presentation will show findings from our study on whether Canadian decedents had access to PC in the last year of life. Data from physician billings, drug claims, home care, long-term care and acute care were linked to identify decedents and PC service use. These data were also used to examine how PC may affect, or be affected by other interactions with the health system, including inpatient alternate level care days, admissions from long-term care, emergency department visits and stays in intensive care units. Gaps in data availability and quality will also be highlighted. ResultsAbout 70% of decedents were identified using administrative health data, although there were variations across jurisdictions due to differences in data availability and quality (9%-81%). For decedents identified across care settings, few received PC in the community in their last year of life, ranging from 4% in long-term care to 12% in home care. More decedents were identified as palliative in acute care (44%) but only one-third received PC in another setting despite multiple interactions with the health system in the last year of life. Those who had integrated, community-based PC were less likely to have a stay in an intensive care unit, and more likely to die in the community. However, few Canadian decedents had access to this type of care. Conclusion/ImplicationsData linkage identified opportunities for earlier integration of PC and improved care transitions. However, lack of common definitions of PC across sectors and jurisdictions, limitations in data availability and issues in PC coding were identified. Improvements in PC data are required to evaluate progress for the future.

scholarly journals The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 629-629
Author(s):  
Silke Metzelthin ◽  
Sandra Zwakhalen ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
The Netherlands ◽  
Home Care ◽  
Acute Care ◽  
Long Term Care ◽  
Functional Decline ◽  
Term Care ◽  
The Us ◽  
The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

scholarly journals Characterization and evolution of infection control practices among SARS-CoV-2 infected healthcare workers of acute care hospitals and long-term care facilities in Quebec, Canada, Spring 2020

2021 ◽  
pp. 1-37
Author(s):  
Sara Carazo ◽  
Denis Laliberté ◽  
Jasmin Villeneuve ◽  
Richard Martin ◽  
Pierre Deshaies ◽  
...  
Keyword(s):  
Acute Care ◽  
Attack Rate ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Exposure Period ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Facilities

ABSTRACT Objectives: To estimate the SARS-CoV-2 infection rate and the secondary attack rate among healthcare workers (HCWs) in Quebec, the most affected province of Canada during the first wave; to describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and to compare the exposures and practices between acute care hospitals (ACHs) and long-term care facilities (LTCFs). Design: Survey of cases Participants: Quebec HCWs from private and public institutions with laboratory-confirmed COVID-19 diagnosed between 1st March and 14th June 2020. HCWs ≥18 years old, having worked during the exposure period and survived their illness were eligible for the survey. Methods: After obtaining consent, 4542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs. Results: HCWs represented 25% (13,726/54,005) of all reported COVID-19 cases in Quebec and had an 11-times greater rate than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants, working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs of LTCFs had less training, higher staff mobility between working sites, similar PPE use but better self-reported compliance with at-work physical distancing. Sub-optimal IPC practices declined over time but were still present at the end of the first wave. Conclusion: Quebec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

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