scholarly journals Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington

2016 ◽  
Vol 96 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Alan Chong W. Lee ◽  
Michael Billings
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Physical Therapist ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Pilot Program ◽  
Nursing Facility ◽  
Skilled Nursing

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

scholarly journals A Simple Physical Therapy Algorithm Is Successful in Decreasing Skilled Nursing Facility Length of Stay and Increasing Cost Savings After Hip Fracture With No Increase in Adverse Events

2021 ◽  
Vol 12 ◽  
pp. 215145932199861
Author(s):  
Murillo Adrados ◽  
Kaicheng Wang ◽  
Yanhong Deng ◽  
Janis Bozzo ◽  
Tara Messina ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Therapy Algorithm ◽  
Program Participant ◽  
Significant Difference

Introduction: Shorter length of stays (LOS) at a Skilled Nursing Facility (SNF) after hip fracture surgery would be expected to lead to costs savings for the healthcare system. Evidence also suggests that shorter SNF stays also leads to improved 30-day outcomes, thus compounding this value proposition. Our Integrated Fragility Hip Fracture Program created a simple algorithm at discharge to provide each post-operative hip fracture patient with an expected SNF LOS. We studied whether this intervention produced a shorter SNF LOS and other observable short-term outcomes. Methods: We retrospectively reviewed all original Medicare hip fracture patients treated with operative fixation who were admitted to our hospital in 2015, 2017 and 2018. We selected patients who were discharged to a single SNF following hospitalization, and excluded patients with incomplete records. The algorithm for the expected LOS recommendation was based on the degree of assistance the patient needed for ambulation: 7 days (“0-person assist”), 14 days (“1-person assist”), or 21 days (“2-person assist”). We compare the SNF LOS of our hip fracture patient population between those discharged to a program participant, those SNF that agreed to this algorithm, and those discharged to a non-program participant SNF. Results: We identified 246 patients meeting our selection criteria. 69 were discharged to a program participant SNF. Patients discharged to a participant SNF had similar baseline demographics and ASA distributions to those discharged to a non-participant provider. There was a statistically significant difference in length of stay between the groups, with program participant patients spending an average of 23 days at the SNF while the control group spent an average of 31 days. (p < 0.001). Program participant discharges were also associated with additional cost savings. There was no significant difference in ED visits within 90 days of discharge. Discussion: SNF LOS for geriatric hip fractures can be decreased with implementation of a simple physical therapy driven algorithm based on the patient’s ambulatory independence at hospital discharge. Conclusion: This is a simple, yet completely unique program that seems to have increased the value of healthcare provided.

scholarly journals Increasing Rehabilitation Therapists’ Confidence Utilizing Evidence-Based Interventions: Pilot Study

2018 ◽  
Author(s):  
Stephanie Hovick ◽  
Ingrid Provident
Keyword(s):  
Physical Therapy ◽  
Occupational Therapy ◽  
Evidence Based Practice ◽  
Physical Therapists ◽  
Skilled Nursing Facility ◽  
Occupational Therapists ◽  
Evidence Based ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Confidence Levels

Evidence-based practice enables rehabilitation therapists to provide the best quality of care and outcomes for patients. However, rehabilitation therapists are often not confident in using evidence in many settings. Purpose. The objective of this evidence-based practice project was to determine if educational small group sessions enhanced occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and a speech and language pathologist’s confidence in utilizing and applying evidence. Method. Eleven rehabilitation therapists of multiple disciplines (occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and a speech and language pathologist) from a skilled nursing facility participated in six educational sessions designed to increase evidence-based practice. A pre- and post-test utilizing the Evidence-Based Practice Profile Questionnaire (EBPPQ), measured change in therapists’confidence regarding evidence-based practice. Results. Results on the Evidence-Based Practice Profile Questionnaire concluded that 7 of 11 rehabilitation therapists reported an increase in confidence levels. Conclusion. Educational small group sessions can be an effective method to assist rehabilitation therapists in developing this confidence. KEYWORDS: Evidence-based practice, confidence levels, rehabilitation therapists, educational sessions, skilled nursing facility

Consultant Pharmacist Drug Therapy Recommendations Acceptance and Rejection from Monthly Drug Regimen Reviews in a Geriatric Nursing Facility: Fourth Year Results and Cost Analysis

2007 ◽  
Vol 42 (8) ◽  
pp. 729-736 ◽  
Author(s):  
James W. Cooper ◽  
William E. Wade ◽  
Christopher L. Cook ◽  
Allison H. Burfield
Keyword(s):  
Repeated Measures ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Rejection Rate ◽  
Drug Regimen ◽  
Acceptance Rate ◽  
Adverse Outcomes ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Monthly Drug

Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.

scholarly journals Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 267-271
Author(s):  
Thomas Dang ◽  
Fanglong Dong ◽  
Greg Fenati ◽  
Massoud Rabiei ◽  
Melinda Cerda ◽  
...  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Skilled Nursing Facility ◽  
Vertebral Osteomyelitis ◽  
Delayed Diagnosis ◽  
Central Canal ◽  
Clinical Syndrome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Central Cord Syndrome

Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis. Case Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy. Discussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition. Conclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging.

scholarly journals Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure

2011 ◽  
Vol 4 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Larry A. Allen ◽  
Adrian F. Hernandez ◽  
Eric D. Peterson ◽  
Lesley H. Curtis ◽  
David Dai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Older Patients ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

Pharmacist-led program to improve transitions from acute care to skilled nursing facility care

2020 ◽  
Vol 77 (12) ◽  
pp. 979-984
Author(s):  
Maria Achilleos ◽  
Jordan McEwen ◽  
Megan Hoesly ◽  
Mark DeAngelo ◽  
Tim Jennings
Keyword(s):  
Acute Care ◽  
Readmission Rate ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Medication Administration ◽  
Pilot Program ◽  
Order Entry ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Transferred Patients

Abstract Purpose A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described. Summary The process of transitioning patients from an acute care facility to a SNF involves multiple steps, with the potential for delays in medication administration. As part of a health system’s effort to evaluate barriers to timely first-dose administration after hospital-to-SNF transfers, a multidisciplinary team was tasked with defining the frequency of missed doses of high-risk medications and identifying reasons for medication administration delays. A retrospective review was conducted to evaluate medication orders for patients discharged from a community hospital and admitted to a SNF from January through June 2017 (the baseline period). This review found that 60% of first doses of high-risk medications were given after the scheduled administration time. One major barrier identified was a delay in entering medication orders in the SNF electronic medical record after SNF admission. It was also observed that 30-day readmission rates for transferred patients exceeded established readmission rate targets. To address identified process barriers, a pharmacist-led pilot program was developed. The program focused on process improvements at the same 2 hospitals and SNF sites during the period of March through May 2018. The pharmacist reviewed, reconciled, and entered medication orders prior to patient arrivals to the SNF. After pharmacist implementation, order entry delays were eliminated, and the mean delay from medication due time to administration was decreased by 68% relative to baseline data. The discharge summaries of 51% of transferred patients were found to contain medication errors, most of which were clarified and resolved prior to SNF admission. It was observed that the 30-day all-cause readmission rate after SNF transfers during the pilot program was 10.4% lower than during the same timeframe of the previous year. Conclusion By implementing a pharmacist-led process for medication management in transitions from acute care to SNF care, major barriers such as delayed medication administration and medication order entry were reduced. In addition, discharge medication errors were addressed and resolved prior to patients’ admission to the SNF.

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