Subacute Care Unit Research Articles

Coordinated-Transitional Care (C-TraC) for Veterans From Subacute Rehabilitation to Home.

To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home. Quality improvement intervention. Veterans discharged from a subacute care unit in the VA Boston Healthcare System's skilled nursing facility. We used the Replicating Effective Programs framework and Plan-Do-Study-Act cycles to adapt the Coordinated-Transitional Care (C-TraC) program to the context of transitions from a VA subacute care unit to home. The major adaptation of this registered nurse-driven, telephone-based intervention was combining the roles of discharge coordinator and transitional care case manager. We report the details of the implementation, its feasibility, and results of process measures, and describe its preliminary impact. Between October 2021 and April 2022, all 35 veterans who met eligibility criteria in the VA Boston Community Living Center (CLC) participated; none were lost to follow-up. The nurse case manager delivered core components of the calls with high fidelity-review of red flags, detailed medication reconciliation, follow-up with primary care physician, and discharge services were discussed and documented in 97.9%, 95.9%, 86.8%, and 95.9%, respectively. CLC C-TraC interventions included care coordination, patient and caregiver education, connecting patients to resources, and addressing medication discrepancies. Nine medication discrepancies were discovered in 8 patients (22.9%; average of 1.1 discrepancies per patient). Compared with a historical cohort of 84 veterans, more CLC C-TraC patients received a post-discharge call within 7days (82.9% vs 61.9%; P= .03). There was no difference between rates of attendance to appointments and acute care admissions post-discharge. We successfully adapted the C-TraC transitional care protocol to the VA subacute care setting. CLC C-TraC resulted in increased post-discharge follow-up and intensive case management. Evaluation of a larger cohort to determine its impact on clinical outcomes such as readmissions is warranted.

P24 Auditing antibiotic course lengths for the management of community-acquired pneumonia and hospital-acquired pneumonia against current NICE guidance

Abstract Background Protracted antibiotic course lengths for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) contribute to increased risk of antibiotic resistance.1 Optimizing antibiotic course length in line with the current national guidance improves patient safety and overall cost savings.1 NICE guidelines state that antibiotic treatment should be stopped at day 5 if patients were afebrile for <48 hours with one or no sign of clinical instability, defined as systolic blood pressure < 90 mmHg, heart rate > 100/minute, respiratory rate > 24/minute, arterial oxygen saturation < 90% or oxygen partial pressure > 60 mmHg in room air.2 Objectives To assess the current prescribing practice for antibiotic course lengths of CAP and HAP across medical specialties at RCHT. Methods A list of patients discharged from medical specialities (respiratory, cardiology, nephrology, gastroenterology, endocrinology and geriatrics) between 1 August and 1 September 2022 with the coded indication of CAP or HAP was requested from the RCHT Informatics Team. Inclusion criteria were any hospitalized patient aged ≥18 years, with a CAP/HAP diagnosis with pulmonary infiltrate on chest X-ray plus at least one symptom including cough, fever, dyspnoea and chest pain. Patients were excluded if having chronic immunosuppression; HIV positive; living in a nursing/care home, onsite subacute care unit or intensive therapy unit (ITU) or palliative care unit within last 14 days; having taken antibiotics 30 days before admission; requiring a longer duration of therapy because of an uncommon cause; requiring a chest tube or having had a condition complicated by extrapulmonary infection.1 For each patient, the patient’s vital signs at day 5 of antibiotic course and the total antibiotic course lengths were recorded. Results A total of 27 patients were assessed for eligibility; of these, 22 patients (81%) met the inclusion criteria, and 5 patients were excluded. Among those excluded, two recently stepped down from ITU, two lived in a nursing/care home and one had taken antibiotics 30 days before admission. Of the 22 patients, 10 patients (45%) received 5 or 6 days of antibiotics for CAP/HAP. The remaining 12 patients (55%) received courses between 7 to 10 days despite meeting the criteria for stopping antibiotics at 5 days. The mean and median of antibiotic course length including all specialities were 6.5 and 6.3 days, respectively. Conclusions This audit demonstrates that almost half of patients with CAP /HAP are being managed with antibiotic courses of fewer than 7 days. Further prescriber and pharmacy team education sessions on appropriate course lengths are needed. There is consideration for an alert notification on EPMA which reminds prescribers to check patient’s vital signs on day 5 when prescribed an antibiotic for the treatment of CAP and HAP. Recommendation would be to reaudit with a longer data collection timeframe and larger sample size.

Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults: A Pilot Randomized Controlled Trial.

The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. A pilot study with a pragmatic, open-label, randomized controlled trial design. One hundred thirty participants were randomized (intervention n = 66, 50.8%; control n = 64, 49.2%). Protocol violations occurred in 48 participants (intervention n = 33, 68.8%; control n = 15, 31.3%). The study setting was a subacute hospital inpatient care unit located in Queensland, Australia. Participants were randomly allocated 1:1 to the intervention (prophylactic dressing plus standard care) or control group (standard care). Standard care included regular PI risk and skin assessments, and selection and implementation of preventive interventions (eg, support surfaces and increased repositioning) from a PI prevention care plan. The sacral dressing was applied for intervention participants immediately following recruitment. Ward and research staff collected data and assessed skin integrity daily; participants were followed up until onset of a PI or up to 28 days without PI occurrence. In addition, retrospective chart reviews were undertaken to verify PI occurrences. Patient comfort and dressing utility were also evaluated. Two (3.0%) participants in the intervention group and 1 (1.6%) in the control group developed a sacral PI. The difference was not statistically significant. Only 1 PI was recorded prospectively, while 2 PIs were identified via retrospective chart review. Participants rated dressing comfort highly, particularly during the first 2 weeks, and nurses rated utility highly. Based on the intention-to-treat results, a sample size of 1799 per arm would be required in a definitive trial. A definitive trial is feasible and warranted. However, the large sample size required in a definitive trial indicates the need for multiple sites.

Using an ATR-FTIR Technique to Detect Pathogens in Patients with Urinary Tract Infections: A Pilot Study.

Urinary tract infections (UTIs) are a leading hospital-acquired infection. Although timely detection of causative pathogens of UTIs is important, rapid and accurate measures assisting UTI diagnosis and bacterial determination are poorly developed. By reading infrared spectra of urine samples, Fourier-transform infrared spectroscopy (FTIR) may help detect urine compounds, but its role in UTI diagnosis remains uncertain. In this pilot study, we proposed a characterization method in attenuated total reflection (ATR)-FTIR spectra to evaluate urine samples and assessed the correlation between ATR-FTIR patterns, UTI diagnosis, and causative pathogens. We enrolled patients with a catheter-associated UTI in a subacute-care unit and non-UTI controls (total n = 18), and used urine culture to confirm the causative pathogens of the UTIs. In the ATR-FTIR analysis, the spectral variation between the UTI group and non-UTI, as well as that between various pathogens, was found in a range of 1800–900 cm−1, referring to the presence of specific constituents of the bacterial cell wall. The results indicated that the relative ratios between different area zones of vibration, as well as multivariate analysis, can be used as a clue to discriminate between UTI and non-UTI, as well as different causative pathogens of UTIs. This warrants a further large-scale study to validate the findings of this pilot research.

Factors Related to Successful Ventilator Weaning in Respiratory Care Center Patients: A Retrospective Chart Review Study

The subacute respiratory care unit is an important relay station where respirator-dependent patients may access subsequent chronic respiratory care. Although there is relatively little information in the literature regarding respirator disconnections in subacute respiratory care units, assisting patients to disconnect successfully from respirators is a primary challenge for care teams. The purpose of this study was to understand respirator disconnections and the factors affecting these events in subacute respiratory care units to improve the effectiveness of ventilator weaning and reduce the burden on families and medical care providers. This was a retrospective chart review study. Patients admitted to the subacute respiratory care unit for respiratory training during the study period from January 2016 to December 2019 were recruited as subjects and the data were collected from the Chang Gung Medical Research Database`s health insurance secondary data using a self-made transcription form. The ventilator weaning success rate of the subjects in this study was 78.5%. A bivariate analysis revealed that consciousness status; disease severity; rapid shallow breathing index; days of hospitalization in a respiratory care center; days of ventilator use; blood urea nitrogen, white blood cell, hemoglobin, and blood albumin levels; and mean caloric intake were each significantly associated with successful ventilator withdrawal. The predictors of ventilator weaning in respiratory care center patients were identified as disease severity, rapid shallow breathing index, days of ventilator use, white blood cell level, and hemoglobin level. Respirator-dependent patients should be evaluated and monitored as early as possible. Moreover, a ventilator weaning plan should be included as a regular testing and monitoring item. Also, a respirator removal program should be provided on a case-by-case basis. Individualized ventilator weaning programs may reduce the burden on families and medical care providers.

Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience

BackgroundThe primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home.AimsWe analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome).MethodsThis retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome.ResultsFrail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home.Discussion and conclusionThe routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.

The Dilemma of Falls in Older Persons: Never Forget to Investigate the Syncope.

Background and objectives: Falls represent a major cause of morbidity, hospitalizations, and mortality in older persons. The identification of risk conditions for falling is crucial. This study investigated the presence of syncope as a possible cause of falls in older persons admitted to a Sub-Acute Care Unit (SACU) with a diagnosis of accidental fall after initial management in an emergency department and acute hospitalization. Materials and methods: A retrospective monocentric study of patients aged ≥65 years, consecutively admitted to a SACU with a diagnosis of fall-related trauma. All patients underwent a complete assessment of the index event and clinical status. Patients were categorized into three groups according to the identified cause of falls: (1) transient loss of consciousness (T-LOC), (2) unexplained fall (UF), and (3) definite accidental fall (AF). Results: A total of 100 patients were evaluated. T-LOC was present in 36 patients, UF in 37, and AF in 27. Of the 36 patients with T-LOC, a probable origin was identified in most cases (n = 33, 91%), 19 subjects (53%) had orthostatic hypotension, 9 (25%) a cardiac relevant disturbance, 2 (6%) a reproduced vaso-vagal syncope, 2 (6%) severe anemia, and 1 (3%) severe hypothyroidism. The T-LOC group was older and more clinically complex than the other groups. Conclusion: In older patients who recently experienced a fall event, the prevalence of syncope is relevant. In frail and clinically complex patients with falls, the identification of the underlying cause is pivotal and can be achieved through prolonged monitoring and a comprehensive assessment of the person.

Emergency Department Interventions for Frailty (EDIFY): Front-Door Geriatric Care Can Reduce Acute Admissions

ObjectivesThe EDIFY program was developed to deliver early geriatric specialist interventions at the emergency department (ED) to reduce the number of acute admissions by identifying patients for safe discharge or transfer to low-acuity care settings. We evaluated the effectiveness of EDIFY in reducing potentially avoidable acute admissions. DesignA quasi-experimental study. SettingED of a 1700-bed tertiary hospital. ParticipantsED patients aged ≥85 years. MeasurementsWe compared EDIFY interventions versus standard care. Patients with plans for acute admission were screened and recruited. Data on demographics, premorbid function, frailty status, comorbidities, and acute illness severity were gathered. We examined the primary outcome of “successful acute admission avoidance” among the intervention group, which was defined as no ED attendance within 72 hours of discharge from ED, no transfer to an acute ward from subacute-care units (SCU) within 72-hours, or no transfer to an acute ward from the short-stay unit (SSU). Secondary outcomes were rehospitalization, ED re-attendance, institutionalization, functional decline, mortality, and frailty transitions at 1, 3, and 6 months. ResultsWe recruited 100 participants (mean age 90.0 ± 4.1 years, 66.0% women). There were no differences in baseline characteristics between intervention (n = 43) and nonintervention (n = 57) groups. Thirty-five (81.4%) participants in the intervention group successfully avoided an acute admission (20.9% home, 23.3% SCU, and 44.2% SSU). All participants in the nonintervention group were hospitalized. There were no differences in rehospitalization, ED re-attendance, institutionalization and mortality over the study period. Additionally, we observed a higher rate of progression to a poorer frailty category at all time points among the nonintervention group (1, 3, and 6 months: all P < .05). Conclusions and ImplicationsResults from our single-center study suggest that early geriatric specialist interventions at the ED can reduce potentially avoidable acute admissions without escalating the risk of rehospitalization, ED re-attendance, or mortality, and with possible benefit in attenuating frailty progression.

Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home.

Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally. About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada. We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home. The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside. The rates of falls and injuries decreased after implementing the Fall TIPS intervention. Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.

Effectiveness of an infection prevention strategy to limit exposure of high-risk patients to COVID-19 in a hospital-based subacute unit: a descriptive report.

The coronavirus (COVID-19) epidemic has put unprecedented stress on hospitals as well as skilled nursing facilities, where reside some of the most vulnerable individuals at high risk of mortality and complications of this infection. This report highlights the strategy and success of hospital infection prevention efforts to protect the residents of an in-hospital subacute unit with 24 at-risk patients with chronic pulmonary disease in northern California. Specific efforts are detailed, with results of surveillance testing reported, including both viral PCR and serological IgG assays. Implications for other long-term subacute care facilities are discussed, as well as advantages and specific challenges for 'distinct part' versus 'free-standing' subacute care units.

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

In recent years, subacute care units (SCUs) have emerged as alternatives to acute hospitalization for selected emergency department (ED) patients who might benefit from a short period of inpatient stay within a less acute setting. We developed a new protocol to directly admit selected older patients from our acute hospital's (AH) ED to the SCU of a partner community hospital, making use of our ED's short-stay ward as a transit area to overcome administrative, financial, and clinical barriers. The new protocol has removed the need for intervening stays of longer than 24 hours at our AH, reduced overall length of stay across both institutions, decreased hospital admissions, and reduced the number of patient hand-offs.

Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario.

Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital's medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.

Implementation of a strategy involving a multidisciplinary mobile unit team to prevent hospital admission in nursing home residents: protocol of a quasi-experimental study (MMU-1 study)

IntroductionNursing home residents represent a particularly vulnerable population experiencing high risk of unplanned hospital admissions, but few interventions have proved effective in reducing this risk. The aim of this research...

PTSD and Trauma-Informed Care in the Long-Term Care Setting

PTSD and Trauma-Informed Care in the Long-Term Care Setting

Delirium Subtypes and Associated Characteristics in Older Patients With Exacerbation of Chronic Conditions

The prevalence and prognosis of delirium motor subtypes are not yet well established. We analyzed the prevalence of motor subtypes of delirium, as well as their risk factors and outcomes, among older vulnerable patients admitted for short-term management of exacerbated chronic conditions. Cohort study of patients aged 65 and older who developed delirium while admitted to a subacute care unit for 12 months (N = 352). Confusion Assessment Method was used to determine the presence of delirium and the Delirium Motor Subtype Scale was used to define the motor subtype. Outcomes included discharge destination, mortality, readmission, and functional trajectories. Out of 352 patients with delirium (mean age= 87.4, 73.6% with dementia), hyperactive delirium was the most prevalent subtype (40.6%), followed by mixed (31%), hypoactive (25.9%), and nonmotor (2.6%). In multivariate models, worse preadmission functional status (odds ratio [OR] [95% confidence interval {CI}] = 0.97 [0.96-0.98]) and higher comorbidity (OR [95% CI] = 1.3 [1.04-1.51]) were associated with an increased risk of hypoactive delirium. In multivariate models adjusted for different variables, including disability, hypoactive delirium was associated with mortality compared with hyperactive delirium (OR [95% CI] = 4.7 [1.6-14]) and mixed delirium (OR [95% CI] = 2.0 [1.02-3.9]) and with worse functional recovery (Beta[95% CI] = -0.2 [-12.0-(-0.4)]). Delirium motor subtypes were associated with different patient characteristics and outcomes. Hypoactive delirium seems to affect more vulnerable patients and to be associated with worse outcomes. More research on the different delirium subtypes could help develop better preventive and management strategies.

Establishing an integrated model of subacute care for the frail elderly.

The current health system in Ontario is not designed to meet the needs of frail older adults. This is particularly true for older adults hospitalized due to exacerbation of chronic illness or medical crisis. This article describes the Subacute Care Unit for the Frail Elderly (SAFE) program, one which is designed to serve frail older patients who are at risk of deconditioning or disability associated with prolonged hospitalization but who may safely return home or to a retirement home following up to 4 weeks of subacute care in a restorative environment. The program centres on an intense restorative and integrated care delivery model. The patient population is medically complex, requiring medical supervision and regular adjustment to the care plan to optimize medical status. Individuals are no longer acutely ill and are considered stable or stabilizing. Care and services are designed to improve outcomes for hospitalized frail older adults by proactively addressing the conditions that contribute to alternate level of care before the deconditioning associated with prolonged hospitalization is experienced.

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

Background: Delirium research is poorly studied in postacute care, a growing setting due to aging populations, as well as in dementia, a critical risk factor for delirium and particularly prevalent in postacute care. We investigated risk factors for delirium and its outcomes in older adults with and without dementia admitted to a subacute care unit (SCU) after exacerbated chronic conditions. Methods: This is a prospective cohort study including patients ≥65 years old admitted to an SCU for 12 months. We collected demographics, comprehensive geriatric assessments, and presence of dementia and delirium at admission. Outcomes included discharge to previous living situation, mortality, and functional evolution. Due to the high prevalence of dementia, a subgroup analysis was performed to investigate specific risk factors for delirium and related outcomes. Results: Of 909 patients (mean age [±SD] 85.8 ± 6.7; 60% women, 47.5% with dementia), 352 (38.7%) developed delirium. The main risk factor for delirium was dementia (HR [95% CI] 5.2 [3.5–7.7]); age, functional status, and urinary tract infections were also independently associated with delirium. In dementia patients, only age (HR [95% CI] 1.0 [1.004–1.1]) and being male (HR [95% CI] 1.7 [1.04–2.6]) were associated with delirium. Delirium was associated with greater mortality (10.8 vs. 3.9%; p < 0.001) and greater functional decline in the entire sample (–12.3 vs. –6.4 Barthel index points; p < 0.001). In the dementia subgroup, patients with delirium experienced greater functional loss (p = 0.013) and less functional recovery (p = 0.025). Conclusions: In older patients admitted to postacute care, dementia is the main risk factor for delirium, and delirium carries worse clinical and functional outcomes. In patients with dementia, delirium is also relevant, since it entails a functional loss at admission and lower functional recovery.

The Australian Aged Care and Its Implications for the Korean Aging Crisis.

The Australian aged care system has evolved for >50 years to support frail older adults and allow them to make informed decisions about their care. Hospitals provide streamlined geriatric services from visits at the Emergency Department to discharges from acute and subacute geriatric care units. Moreover, nonhospital aged care services, including Transition Care Program, Commonwealth Home Support Program, Home Care Packages Program, and Residential Care (nursing home) are provided under the auspices of the Australian Government. These various specialized hospital and nonhospital services are integrated and coordinated by the multidisciplinary assessment team called ACAT (Aged Care Assessment Team). Korea does not have a similar amount of time to prepare a well-organized aged care system because of a rapidly increasing older population. The Korean government and aged care experts should exert vigorous efforts to improve the last journeys of the Korean older population.

Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool.

SUMMARYThe large majority of the available dysphagia screening tools has been developed for the stroke population. Only few screening tools are suitable for heterogeneous groups of patients admitted to a subacute care unit. The Royal Brisbane and Women's Hospital (RBWH) dysphagia screening tool is a nurse-administered, evidence-based swallow screening tool for generic acute hospital use that demonstrates excellent sensitivity and specificity. No Italian version of this tool is available to date. The aim of this study was to determine the reliability and screening accuracy of the Italian version of the RBWH (I-RBWH) dysphagia screening tool. A total of 105 patients consecutively admitted to a subacute care unit were enrolled. Using the I-RBWH tool, each patient was evaluated twice by trained nurses and once by a speech and language pathologist (SLP) blind to nurses' scores. The SLP also performed standardised clinical assessment of swallowing using the Mann assessment of swallowing ability (MASA). During the first and the second administration of the I-RBWH by nurses, 28 and 27 patients, respectively, were considered at risk of dysphagia, and 27 were considered at risk after SLP assessment. Intra- and inter-rater reliability was satisfactory. Comparison between nurse I-RBWH scores and MASA examination demonstrated a sensitivity and specificity of the I-RBWH dysphagia screening tool up to 93% and 96%, respectively; the positive and negative predictive values were 90% and 97%, respectively. Thus, the current findings support the reliability and accuracy of the I-RBWH tool for dysphagia screening of patients in subacute settings. Its application in clinical practice is recommended.

Analysis of Casuistry and Results of the Implementation of a Care Programme in Ten Sub-Acute Care Units in Catalonia

Introduction : Several studies show that a high percentage of people admitted to acute care hospitals could be treated in alternative care facilities of less intensity. The hospitalisation of fragile elderly people or people with chronic illnesses can give rise to various complications, as well as represent a high cost in terms of healthcare. In recent years, as an alternative to conventional hospitalisation, a number of new specific units have been set up in intermediate care hospitals in Catalonia: sub-acute care units. Their goal is to guarantee the care continuum with a geriatric rehabilitation approach from the outset, for those multi-pathological elderly patients with decompensation, who call for treatment and control of their pathologies. Sub-acute care becomes an alternative to conventional hospitalisation, with the contribution of interdisciplinary treatment plans to the complex needs of patients with chronic illnesses. They are people that call for patient-centred care, over and above managing the illness. In this setting, the rehabilitation therapies they need can be applied, with an integrated care focus and at a lower cost, in order to achieve improved health outcomes, more rapid functional improvement and with a care continuum process that is better adapted to their needs. Objective : To appraise the improvement in care for people with complex chronic illnesses, in the context of comprehensive and integrated care, through on-going care and an adaptation of resources tailored to patient needs, through the implementation of sub-acute care units in the realm of intermediate care. A sample of 591 cases admitted to eleven sub-acute care units across Catalonia were collected in a defined period of time, from February to March 2015. The care process and its outcomes, as well as their adjustment to the standards established for this resource, were analysed. Methodology : A statistical analysis of the sample endeavours to classify it into different areas that allow us to identify the socio-demographic and epidemiological profile of treated patients, as well as characteristics of the care process and its results. An emphasis has been placed on the analysis of readmissions, the level of dependence upon admission and release (Barthel) and mortality during admission and at six months of care, among other elements. Results : The analysis of the sample has identified that the average age of treated patients is 86 years of age, 63% of whom are women. Thirty-seven per cent of treated patients are complex chronic patients, and 17% are patients with advanced chronic illness. Eighty-two per cent of patients originate from emergency services, 8% from primary healthcare and 6% from nursing homes. The average length of stay is ten days. The most prevalent diagnosis, 55% of cases, involves respiratory illnesses, and 20% account for circulatory system illnesses. The number of readmissions a month after release stands at approximately 20%. The rate of mortality upon release is 18%, and 30% after six months. Conclusions : Sub-acute care units are an alternative to conventional hospitalisation that offer a specific and agile care system for geriatric patients with decompensation treated in emergency services or detected in primary care. Care becomes personalised, treating their many pathologies and their personal and context-based determining factors, which do not require cutting-edge diagnosis or therapy, but rather a stay in a facility with an interdisciplinary, person-centred approach, and where the possibility for functional recovery appropriate for the geriatric patient is offered, which allows them to return to their usual environment in the same or similar functional conditions they had previous to the acute decompensation of their chronic disease.