Long-term Care Hospitals Research Articles

Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study.

To investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults. A retrospective study using nationwide longitudinal cohort data. A total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service-Senior cohort. Depressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty. Participants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05-1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44-2.68), LTCS use (HR 4.86, 95% CI 3.45-6.84), and LOS (IRR 1.30, 95% CI 1.06-1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16-2.07). Our findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.

Quantitative image analysis in COVID-19 acute respiratory distress syndrome: a cohort observational study.

Background Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury commonly associated with pneumonia, including coronavirus disease-19 (COVID-19). The resultant effect can be persistent lung damage, but its extent is not known. We used quantitative high resolution computed tomography (QHR-CT) lung scans to radiographically characterize the lung damage in COVID-19 ARDS (CARDS) survivors. Methods Patients with CARDS (N=20) underwent QHR-CT lung scans 60 to 90 days after initial diagnosis, while hospitalized at a long-term acute care hospital (LTACH). QHR-CT assessed for mixed disease (QMD), ground glass opacities (QGGO), consolidation (QCON) and normal lung tissue (QNL). QMD was correlated with respiratory support on admission, tracheostomy decannulation and supplementary oxygen need on discharge. Results Sixteen patients arrived with tracheostomy requiring invasive mechanical ventilation. Four patients arrived on nasal oxygen support. Of the patients included in this study 10 had the tracheostomy cannula removed, four remained on invasive ventilation, and two died. QHR-CT showed 45% QMD, 28.1% QGGO, 3.0% QCON and QNL=23.9%. Patients with mandatory mechanical ventilation had the highest proportion of QMD when compared to no mechanical ventilation. There was no correlation between QMD and tracheostomy decannulation or need for supplementary oxygen at discharge. Conclusions Our data shows severe ongoing lung injury in patients with CARDS, beyond what is usually expected in ARDS. In this severely ill population, the extent of mixed disease correlates with mechanical ventilation, signaling formation of interstitial lung disease. QHR-CT analysis can be useful in the post-acute setting to evaluate for interstitial changes in ARDS.

Development of a Tool to Measure Compliance with Infection Prevention Activities Against Emerging Respiratory Infectious Diseases among Nurses Working in Acute Care and Geriatric Hospitals.

This study developed a preliminary instrument to measure nurses' infection prevention compliance against emerging respiratory infectious diseases and to verify the reliability and validity of the developed instrument. The participants were 199 nurses working at a university hospital with more than 800 beds and two long-term care hospitals. Data were collected in May 2022. The final version of the developed instrument consisted of six factors and 34 items, with an explanatory power of 61.68%. The six factors were equipment and environment management and education, hand hygiene and respiratory etiquette, infection risk assessment and flow management, protection of employees in contact with infected patients, ward access management of patients with infectious diseases, and wearing and removing personal protective equipment. We verified the convergent and discriminant validities of these factors. The instrument's internal consistency was adequate (Cronbach's α=0.82), and the Cronbach's α of each factor ranged from 0.71 to 0.91. This instrument can be utilized to determine the level of nurses' compliance with infection prevention activity against emerging respiratory infectious diseases and will contribute to measuring the effectiveness of future programs promoting infection-preventive activities.

Evaluation of Outpatient Access to the Greek Health System Considering the Constraints of the COVID-19 Pandemic.

Background The COVID-19 pandemic fundamentally changed the way healthcare is delivered in most healthcare systems around the world. It is now known that, in addition to the medical and economic impact of the pandemic on societies, there is another unmet medical need due to the difficulties and barriers that have existed and may still exist in the provision of health services at the primary care level in public hospitals. In Greece, there appears to have been a similar problem in citizens' access to health care in the country's public hospitals, which negatively affected the satisfaction of outpatients and significantly prevented them from receiving the medical care they needed. Methods This study relied on two international questionnaires; the Visit Specific Satisfaction(VSQ-9), an instrument measuring patients' satisfaction with their visit to the physician, and the Patient Satisfaction Questionnaire Short-Form(PSQ-18), consisting of 18 questions measuring both satisfaction and dissatisfaction. The questionnaires were collected electronically between 01.03.22 and 20.03.22 from two hundred and three outpatient residents of the region of Eastern Macedonia and Thrace in Greece. Results The results of the study show that satisfaction of hospital outpatient department users is positively influenced by both access to medical care after the last visit (p=0.008 < 0.05) and frequency of visits (Pearson correlation coefficient=0.178, p=0.012). In addition, lower satisfaction with access to care was found among participants with the lowest income (p=0.010) and those with a chronic illness (p=0.002), which was attributed to pandemic limitations in access to health care services in public hospital outpatient departments. Regarding the overall satisfaction of participants, 40.9% were dissatisfied, and 32.5% were dissatisfied with specific hospital services. Conclusions It was found that patients were hindered from accessing medical care in the hospital due to the restrictions caused by the pandemic. This seemed to cause problems both in accessing a specialist and in making appointments. Half of the outpatients in the samplereported having difficulty communicating with the hospital to make an appointment or to access medical services in general. A relationship was also found between patient satisfaction and the quality of services provided, in terms of medical services offered, such as their availability, and patient satisfaction with the appropriate information they receive from physicians during the pandemic period. The study also found that long-term care hospitals need to improve patient satisfaction with existing medical services.

Prognostic variables and decannulation of tracheostomy in the long-term acute care environment: a case for clinician-driven decision-making.

Tracheostomy is a necessary procedure required for prolonged mechanical ventilation in long-term acute care hospitals (LTACH). Many factors influence successful decannulation, or tracheostomy removal, and it is unclear what factors are essential for determining decannulation. The purpose of this study was to determine retrospective performance of single prognostic variables for successful decannulation, like peak expiratory flow measurement, overnight oximetry testing, and blood gas analysis. A retrospective analysis of a three-year period to investigate the association between peak flow (PF) measurements ≥160 L/min, successful overnight oximetry (ONO), sex, and decannulation success. Average PF measurements, arterial blood gas (ABG), days on mechanical ventilation, LTACH length of stay (LOS), and age were also investigated. We examined the records of 135 patients, 127 of which were successfully decannulated. PF measurements ≥160 L/min (p=0.16), sex (p<0.05) and passing ONO (p<0.05) were significantly different between successfully and unsuccessfully decannulated patients; mean ABG (pH, pCO2, pO2), mechanical ventilation days, LOS, and age were not significantly different (p>0.05). These results suggest no single prognostic variable can predict decannulation outcomes. Rather, clinical judgment of experienced medical professionals appears sufficient to achieve a 94% decannulation success rate. Additional investigation is required to determine what metrics are necessary, or if clinical judgment alone can predict decannulation success.

A Survey on Scabies Inpatients in South Korea Based on Health Insurance Claims Data from 2010 to 2019

Due to the growing aging population and the increased number of long-term patients staying in nursing facilities, the prevalence of scabies has recently been increasing, even in developed countries. This study aimed to identify the actual status of hospitalized patients with scabies in South Korea using the national health insurance claims data. From 2010 to 2019, 2586 patients were hospitalized with scabies (B86) as the primary diagnosis. There were more females than males (χ2 = 31.960, p < 0.001) and patients aged 80 years or older in long-term care hospitals (χ2 = 431.410, p < 0.001). Scabies patients were mainly hospitalized in internal medicine, family medicine, and dermatology for all provider types (χ2 = 170.033, p < 0.001). In long-term care hospitals, the rate of accompanying dementia was 31.9% (χ2 = 193.418, p < 0.001), cerebral infarction was 10.4% (χ2 = 106.271, p < 0.001), and cancer was 2.1% (χ2 = 17.963, p < 0.001), which was higher than other provider types. Additionally, 20.6% in general hospitals (χ2 = 198.952, p < 0.001) had an indwelling catheter, while 49.1% in hospitals and 41.1% in general hospitals were administered steroids (χ2 = 214.440, p < 0.001). The KOH smear test was performed in 11.3% of all inpatients with scabies. We suggest recognizing these characteristics of scabies patients and thoroughly checking the skin lesions during physical examination for early diagnosis and prevention of scabies infection.

Development and Evaluation of Rehabilitation Service Areas for the United States

BackgroundGeographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries.MethodsA patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward’s clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data (n = 2,730,366) to develop the RSAs and 2015 data (n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries.ResultsThe method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care.ConclusionsRehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.

Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care.

To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.

The association between beta-natriuretic peptide (BNP) serum levels and liberation from mechanical ventilation.

Prolonged time on mechanical ventilation is associated with multiple consequences for both the patient and medical facility. Based on anecdotal evidence that sustained elevation of beta-natriuretic protein (BNP) during a patient's stay in a long-term acute care hospital (LTACH) was associated with failure to wean from prolonged mechanical ventilation, we investigated if there is an association between a decrease in BNP levels during one's stay and successful weaning from prolonged mechanical ventilation. We performed a retrospective study of 66 patient records revealing no correlation between lowering BNP levels and probability of liberating a patient from prolonged mechanical ventilation in an LTACH environment where the probability of liberation from mechanical ventilation is high (> 85%). BNP measurements by itself does not appear to be a helpful tool in the likelihood of liberation from mechanical ventilation AUC = 0.61 (CI: 0.48-0.72). In an LTACH setting with high success rates of liberation from mechanical ventilation, it does not appear to be necessary to trend BNP measurements in attempts to liberate patients from prolonged mechanical ventilation.

The Influence of Long-term Care Hospital Nurses' Nursing Professionalism and Knowledge of COVID-19 on Nursing Intentions for COVID-19 Patients

Purpose: This study attempted to identify the influence of long-term care hospital nurses' nursing professionalism and knowledge of coronavirus disease 2019 (COVID-19) on nursing intentions for COVID-19 patients.Methods: Data were collected from nurses who had worked for at least 6 months at long-term care hospitals with more than 100 beds located in North Gyeongsang Province from July 15 to 31, 2021. In total, 207 questionnaires were analyzed using the t-test, one-way analysis of variance, Pearson correlation coefficients, and multiple linear regression with SPSS for Windows version 25.0.Results: Among the sub-factors constituting nursing professionalism, self-concept of the profession (r=.22, &lt;i&gt;p&lt;/i&gt;=.001) and professionalism of nursing (r=.23, &lt;i&gt;p&lt;/i&gt;=.001) were correlated with nursing intention for COVID-19 patients, whereas there no correlation was found between knowledge of COVID-19 and nursing intention for COVID-19 patients. In addition, among the sub-factors of nursing professionalism, the only factor influencing nursing intention for COVID-19 patients was professionalism of nursing, which could explain approximately 6.0% of variance in nursing intention for COVID-19 patients (β=.58, &lt;i&gt;p&lt;/i&gt;=.049).Conclusion: It is important to strengthen professionalism of nursing among various aspects of nursing professionalism in order to improve long-term care hospital nurses’ nursing intention for COVID-19 patients.

Implementation of a free water protocol at a long term acute care hospital

This feasibility study aimed to trial a Free Water Protocol (FWP) for patients with thin liquid dysphagia in the Long-Term Acute Care Hospital (LTACH) setting. Patients with dysphagia are often prescribed thickened liquids to avoid or mitigate aspiration. While this clinical intervention can minimize the risk of aspiration pneumonia (PNA), it is generally not well received by patients. As such, the goal of this study was to determine if patients who knowingly aspirate thin liquids can safely tolerate thin liquid water, and if so, to what degree of benefit. The study assessed for adverse events, fluid intake, hydration status, quality of life, and overall swallow function outcomes. These measurements were taken over a 7 day trial period using inventories, lab work, clinical judgment, and observation. Ten participants were enrolled in this study with 9 having sufficient data for analysis (n = 9). No adverse events related to the FWP were observed, and patients saw improved total fluid intake (P = 0.0074), swallow-related quality of life (P = 0.0273), and overall swallow function (P = 0.0002). The results in this feasibility study allowed for the hospital wide implementation of the FWP and laid out the groundwork for future studies looking at longitudinal effects of a FWP.

Driving Outcomes and Improving Documentation with Long-Wave Infrared Thermography in a Long-term Acute Care Hospital.

Hospital-acquired pressure injuries (HAPIs) have been increasing nationally, and unfortunately, long-term acute care hospitals (LTACHs) continue to report the highest prevalence and incidence. 1,2 To help reduce HAPI rates and to increase healing rates of all pressure injuries (PIs), including those that are present on admission, a 23-bed LTACH implemented a HAPI prevention and treatment protocol using new technology as a tool for patient skin assessments. A 75-day evaluation using long-wave infrared thermography (LWIT) was conducted for all patients admitted to the facility in conjunction with new PI treatment and prevention bundles that were created by the skin care team. Every PI was imaged using LWIT, which provided a photographic image of the PI, as well as a thermal image of the subcutaneous tissue underneath. This enabled staff to implement treatment and prevention measures as soon as possible. After the 75-day evaluation, the LTACH decided to make LWIT a permanent tool in their HAPI treatment and prevention program. For 10 months, the LTACH sustained a zero HAPI rate using the new treatment and prevention program including LWIT. The LTACH demonstrated that LWIT technology was an invaluable tool in the prevention and treatment of PIs. The use of LWIT has become common practice in this facility. The LTACH facility maintained a zero HAPI rate for 10 months after implementation of LWIT.

Development and Application of an Educational-Training Programme for Infection Control Practitioners in Long-Term Care Hospitals

Elderly persons are at risk of infection due to underlying diseases and weak immune systems. All elderly persons do not require hospitalization in LTCHs, even if have chronic illness or weakened immune systems, but they require care in long-term care hospitals (LTCHs) that have well-trained infection control practitioners (ICPs). This study aimed to develop an educational-training programme for ICPs working in LTCHs using the Developing A Curriculum (DACUM) method. Based on the results of the literature review and the DACUM committee workshop, 12 duties and 51 tasks of ICPs were identified. A total of 209 ICPs participated in the survey, rating 12 duties and 51 tasks on a 5-point scale in terms of frequency, importance, and difficulty. An educational-training programme consisting of five modules was developed, focusing on tasks higher than the mean for each of frequency (2.71 ± 0.64), importance (3.90 ± 0.05), and difficulty (3.67 ± 0.44). Twenty nine ICPs participated in a pilot educational-training programme. The mean programme satisfaction level was 93.23 (standard deviation: ±3.79 points) out of 100 points. The average total knowledge and skill scores were significantly higher after the programme (26.13 ± 1.09, 24.91 ± 2.46, respectively) than before the programme (18.89 ± 2.39, 13.98 ± 3.56, respectively) (p < 0.001, p < 0.001, respectively). This programme will improve the knowledge and skills of ICPs, and thereby contribute to the reduction in healthcare-associated infections in LTCHs.

Assessment and Coping Bahavior of Nurses to Aggressive Behavior of Dementia Patients in Long-term Care hospital

Assessment and Coping Bahavior of Nurses to Aggressive Behavior of Dementia Patients in Long-term Care hospital

Comparison of Terminal Care Stress and Terminal Care of Long-term Care Hospital Nurses and Nursing Staff

Comparison of Terminal Care Stress and Terminal Care of Long-term Care Hospital Nurses and Nursing Staff

Experiences of Nurses with COVID-19 Infection Management in General Hospitals and Long-term Care Hospitals

The purpose of this study was to understand and describe the experiences of nurses in general and long-term care hospitals in infection management related to COVID-19. The participants were 10 nurses working at general and long-term care hospitals located in G province. Data were collected through interviews with three focus groups conducted from June to July 2021. All interviews were audiotaped and transcribed verbatim. The collected data were analyzed using qualitative content analysis. As a result, 62 codes, 9 subcategories, and 4 categories were extracted. The four themes were as follows: (1) the sudden emergence of COVID-19 and the unending uncertainty, (2) various efforts to prevent and manage COVID-19, (3) facilitators and barriers in managing COVID-19, and (4) suggestions for strengthening infection management. Based on the results, an educational program to enhance the infection management competency of nurses should be developed and applied considering the characteristics of general and long-term hospitals. Moreover, practical policies such as preparing a network for infection management should be prepared.

The Impact of Tunneled Central Venous Hemodialysis Catheter on Mortality of Elderly Hemodialysis Patients Hospitalized in a Long-Term Care Hospital

Introduction: The association between tunneled central venous hemodialysis catheters (TCVCs) and mortality in hospitalized elderly hemodialysis (HD) patients remains unclear. Methods: This retrospective observational study was conducted in a long-term care hospital. We evaluated the association between TCVC and mortality in HD patients hospitalized between 2015 and 2020. Results: A total of 463 patients were compared: TCVC group (n = 53) and non-TCVC group (n = 410) including arteriovenous fistula (AVF, n = 369), arteriovenous graft (AVG, n = 30), and superficialized brachial artery (SBA, n = 11). The mean ages were 80 and 78 years in the TCVC and non-TCVC groups, respectively. Overall mortality rates for all-cause and cardiovascular diseases (CVDs) were higher in the TCVC group than in the non-TCVC group (log-rank, p = 0.01, and p = 0.009). Overall mortality was higher in the TCVC group than in the AVF group (p = 0.04), but there were no significant differences between the TCVC, AVG, and SBA groups. In Cox proportional hazards regression models, age, dialysis vintage, male sex, Charlson Comorbidity Index (CCI), and serum albumin level were associated with all-cause, CVD, and infectious disease (ID) mortalities, but TCVC was not associated with all-cause (hazard ratio, 1.31; 95% confidence interval, 0.95–1.80; p = 0.1), CVD (1.54; 0.99–2.39; p = 0.051), and ID (0.91; 0.48–1.70; p = 0.8) mortalities. Among patients aged ≥80 years, with dialysis vintage ≥7 years and CCI ≥10, the overall mortality rates were comparable between the two groups. Conclusions: Among elderly HD patients in the long-term care hospital, TCVC was not associated with mortality.

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis.

Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. It has been researched extensively in the stroke population, showing reduced length of stay for patients and improved functional outcomes. This systematic review aims to explore the totality of evidence for the use of ESD in an older adult population who have been hospitalised with medical complaints. Systematic searches were conducted in MEDLINE, CINAHL, Ebsco, Cochrane Library and EMBASE. Randomised controlled trials (RCTs) and quasi-RCTs were included if they provided an ESD intervention to older adults admitted to hospital for medical complaints compared with usual inpatient care. Patient and process outcomes were explored. The Cochrane Risk of Bias Tool was used to assess methodological quality. A meta-analysis was conducted using RevMan 5.4.1. Five RCTs met the inclusion criteria. The quality of the trials was mixed overall, with high levels of heterogeneity. ESD demonstrated a statistically significant reduction in length of stay (MD -6.04 days, 95% CI -9.76 to -2.32) and improvements in function, cognition, and health-related quality of life, with no increased risk of long-term care admission, hospital re-admission or mortality in the ESD interventions versus usual care groups. This review demonstrates that ESD positively impacts patient and process outcomes for older adults. Further consideration should be given to exploring the experiences of those involved in ESD including older adults, family members/caregivers as well as healthcare professionals.

Impact of malnutrition evaluated by the mini nutritional assessment on the prognosis of acute hospitalized older adults.

Malnutrition is prevalent among hospitalized older patients. Therefore, this study aimed to investigate the association between nutritional status [assessed using the Mini Nutritional Assessment (MNA) and serum albumin levels] and adverse outcomes in hospitalized older patients. We also aimed to compare the predictive utility of our findings. This retrospective cohort study was conducted between January 2016 and June 2020. In total, 808 older patients (aged ≥ 65 years, mean age 82.8 ± 6.70 years, 45.9% male) admitted to the acute geriatric unit were included in our sample. Comprehensive geriatric assessments, including the MNA, were performed. Malnutrition and risk of malnutrition were defined as MNA < 17, albumin < 3.5 g/dL and 17 ≤ MNA ≤ 24, 3.5 g/dL ≤ albumin < 3.9 g/dL, respectively. The primary outcome was that patients could not be discharged to their own homes. The secondary outcomes were overall all-cause mortality, 3-month all-cause mortality, and incidence of geriatric syndrome, including delirium, falls, and newly developed or worsening pressure sores during hospitalization. Poor nutritional status was associated with older age; female sex; admission from the emergency room; high risk of pressure sores and falls; lower physical and cognitive function; higher depressive score; and lower serum albumin, protein, cholesterol, and hemoglobin levels. In the fully adjusted model, malnutrition assessed using the MNA predicted discharge to nursing homes or long-term care hospitals [odds ratio (OR) 5.822, 95% confidence interval (CI): 2.092-16.199, P = 0.001], geriatric syndrome (OR 2.069, 95% CI: 1.007-4.249, P = 0.048), and 3-month mortality (OR 3.519, 95% CI: 1.254-9.872, P = 0.017). However, malnutrition assessed using albumin levels could only predict 3-month mortality (OR 3.848, 95% CI: 1.465-10.105, P = 0.006). The MNA predicted 3-month mortality with higher precision than serum albumin levels (P = 0.034) when comparing the areas under the receiver operating characteristic curve. Nutritional risk measured by the MNA was an independent predictor of various negative outcomes in hospitalized older patients. Poor nutritional status assessed by serum albumin levels, the most widely used biochemical marker, could predict mortality, but not the development of geriatric syndrome or discharge location reflecting functional status.

Rapid Response Systems at a Long-Term Acute Care Hospital.

Rapid Response Systems (RRS) improve patient outcomes at large medical centers. Little is known about how RRS are used in other medical settings. The purpose of this exploratory study was to describe RRS events at a long-term acute care hospital (LTACH). We conducted a retrospective review of 71 RRS event records at an urban 50-bed Midwestern LTACH. Measures included demographic data, triggering mechanisms, contextual factors, mechanism factors, and clinical outcomes. Of patients who experienced a RRS event, median age was 71 (62, 80) years; 52.1% were female; most (n = 49, 69%) were "full code." Most (n = 41, 58%) events occurred during the daytime. The most common trigger was "mental status changes/unresponsiveness." Registered nurses were the most frequent activator (n = 19, 26.8%) and responders (n = 63, 60.6%). Median duration of RRS events was 14 (6, 25) minutes. Most patients stabilized and their condition improved (n = 54, 76.1%). RRS can be expanded and modified to the LTACH population.