The Long-Term Acute Care Hospital: A New Option for Ventilator-Dependent Individuals

Improved health care and sophisticated medical technology have improved the outcome for many people who suffer a critical illness. One group of people who have benefited are ventilator-dependent individuals (VDIs), as evidenced by the increased number of children and adults requiring long-term mechanical ventilation. Significant changes in this nation’s health care reimbursement structure have made a substantial negative impact on the availability of traditional long-term care options for these patients. In response, a new health care environment has emerged. Now available are specialty hospitals providing general hospital services, which allow for long-term acute care intervention. The Vencor Corporation has successfully established this innovative care environment in a cost-effective manner. There are currently nine Vencor hospitals specializing in providing long-term acute care to VDIs and other catastrophically ill patients

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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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1306 ◽

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.

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Management challenges faced by managers of New Zealand long-term care facilities

Australian Health Review ◽

10.1071/ah000100 ◽

2000 ◽

Vol 23 (1) ◽

pp. 100 ◽

Cited By ~ 1

Author(s):

Eshwar Madas ◽

Nicola North

Keyword(s):

Long Term Care ◽

Postal Survey ◽

Single Type ◽

Continuing Care ◽

Care Hospital ◽

Health Care Environment ◽

Term Care ◽

Care Environment ◽

Care Managers

This article reports on a postal survey of 78 long-term care managers in one region ofNew- Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) weremiddle-aged females holding nursing but not management qualifications. Most long-termcare facilities (69%) tended to be stand-alone facilities providing a single type of care (resthome or continuing care hospital). The most prominent issues facing managers wereconsidered to be inadequate funding to match the growing costs of providing long-term careand occupancy levels. Managers believed that political/regulatory, economic and social factorsinfluenced these issues. Despite a turbulent health care environment and the challenges facingmanagers, long-term care managers reported they were coping well and valued networking.

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Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2009.03024.x ◽

2010 ◽

Vol 16 (7) ◽

pp. 934-944 ◽

Cited By ~ 108

Author(s):

A. March ◽

R. Aschbacher ◽

H. Dhanji ◽

D.M. Livermore ◽

A. Böttcher ◽

...

Keyword(s):

Acute Care ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Facility ◽

Care Hospital ◽

Term Care ◽

Long Term Care Facility ◽

Geriatric Unit ◽

Multiresistant Bacteria

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Agitation in Demented Patients in an Acute Care Hospital: Prevalence, Disruptiveness, and Staff Burden

International Psychogeriatrics ◽

10.1017/s1041610201007578 ◽

2001 ◽

Vol 13 (2) ◽

pp. 183-197 ◽

Cited By ~ 67

Author(s):

Rosa Sourial ◽

Jane McCusker ◽

Martin Cole ◽

Michal Abrahamowicz

Keyword(s):

Acute Care ◽

Nursing Staff ◽

Barthel Index ◽

Long Term Care ◽

Acute Care Hospital ◽

Patient Characteristics ◽

Care Hospital ◽

Term Care ◽

Research Attention

Background/literature review: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff. Method: The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints. Results: Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden. Discussion: The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.

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Clostridium difficileInfection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

Infection Control and Hospital Epidemiology ◽

10.1086/660767 ◽

2011 ◽

Vol 32 (7) ◽

pp. 656-660 ◽

Cited By ~ 41

Author(s):

Jong Hun Kim ◽

Diana Toy ◽

Robert R. Muder

Keyword(s):

Acute Care ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Facility ◽

Optimal Strategies ◽

Care Hospital ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility

Background.Controversy exists over whetherClostridium difficileinfection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.Objective.To assess the incidence and outcome of CDI in a long-term care facility.Methods.Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stoolC. difficiletoxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.Results.The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P= .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%;P= .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07;P= .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95;P= .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05;P= .005) were associated with relapse of CDI.Conclusions.Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

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Repeated Prevalence Surveys and Admission Screening for Candida auris at One Long-Term Acute-Care Hospital, Chicago, 2016–2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.487 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s14-s15

Author(s):

Massimo Pacilli ◽

Kelly Walblay ◽

Hira Adil ◽

Shannon Xydis ◽

Janna Kerins ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospital ◽

Venous Catheter ◽

Patient Characteristics ◽

Care Hospital ◽

Candida Auris ◽

Term Care ◽

Medical Issues ◽

Admission Screening

Background: Since the initial identification of Candida auris in 2016 in Chicago, ongoing spread has been documented in the Chicago area, primarily among older adults with complex medical issues admitted to high-acuity long-term care facilities, including long-term acute-care hospitals (LTACHs). As of October 2019, 790 cases have been reported in Illinois. Knowing C. auris colonization status on admission is important for prompt implementation of infection control precautions. We describe periodic facility point-prevalence surveys (PPSs) and admission screening at LTACH A. Methods: Beginning September 2016, we conducted repeated PPSs for C. auris colonization at LTACH A. After a baseline PPS, we initiated admission screening in May 2019 for patients without prior evidence of C. auris colonization or infection. C. auris screening specimens consisted of composite bilateral axillary/inguinal swabs tested at public health laboratories. We compared a limited set of patient characteristics based on admission screening results. Results: From September 2016 through October 2019, 277 unique patients were screened at LTACH A during 10 PPSs. Overall, 36 patients (13%) were identified to be colonized. The median facility C. auris prevalence increased from 2.8% in 2016 to 37% in 2019 (Fig. 1). During May–September 2019, among 174 unique patients admitted, 151 (87%) were screened for C. auris colonization on admission, of whom 18 (12%) were found to be colonized. Overall, 14 patients were known to have C. auris colonization on admission and were not rescreened, and 9 patients were discharged before screening specimens could be collected. A significantly higher proportion of patients testing positive for C. auris on admission had a central venous catheter or a peripherally inserted central catheter or were already on contact precautions (Table 1). The PPS conducted on October 1, 2019, revealed 5 new C. auris colonized patients who had screened negative on admission. Conclusions: Repeated PPSs at LTACH A indicated control of C. auris transmission in 2016–2017, followed by increasing prevalence beginning in May 2018, likely from patients admitted with unrecognized C. auris colonization and subsequent facility spread. Admission screening allowed for early detection of C. auris colonization. However, identification during subsequent PPS of additional colonized patients indicates that facility transmission is ongoing. Both admission screening and periodic PPSs are needed for timely detection of colonized patients. Given the high C. auris prevalence in LTACHs and challenges in identifying readily apparent differences between C. auris positive and negative patients on admission, we recommend that all patients being admitted to an LTACH in endemic areas should be screened for C. auris.Funding: NoneDisclosures: None

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