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Dulcelina A. Stahl - One of the best experts on this subject based on the ideXlab platform.
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Anatomy of a management system.
Nursing Management, 1997Co-Authors: Dulcelina A. StahlAbstract:While a Management System is no panacea for success in managed Care, not having such a system can be bazardous to the health of a Subacute Care facility. The eight components of the Management System and how they relate to Subacute Care are discussed.
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Direct contracting: a new wave for Subacute Care.
Nursing management, 1997Co-Authors: Dulcelina A. StahlAbstract:Direct contracting, called "the wave of the future," poses particular challenges in two key areas for Subacute Care providers: quality of Care and price. Using this process, employer groups bypass managed Care organizations and directly contract with health Care providers.
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Customer service: the key to market differentiation.
Nursing management, 1997Co-Authors: Dulcelina A. StahlAbstract:Fierce competition in the Subacute Care environment makes customer service orientation essential. Four steps help to achieve quality customer service are: (1) institute core values; (2) identify your customers; (3) understand human resources; and (4) establish an efficient system.
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Business ethics: implications for managed Care contracts.
Nursing management, 1997Co-Authors: Dulcelina A. StahlAbstract:Business ethics is a specialized study that emphasizes how moral standards apply to organizations, policies, procedures and behavior. Moral standards must be considered to understand the implications of business ethics in Subacute Care.
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Managing risks in Subacute Care.
Nursing management, 1997Co-Authors: Dulcelina A. StahlAbstract:Risk management should improve the quality of Care and clinical outcomes as well as prevent litigation. A systematic risk-management program needs objectives, goals, benchmarks and a continuous quality improvement approach. Three basic tenets help: quality, evaluation and utilization management.
Kate H. Moore - One of the best experts on this subject based on the ideXlab platform.
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Urinary incontinence in Subacute Care--a retrospective analysis of clinical outcomes and costs.
The Medical journal of Australia, 2003Co-Authors: Janette P Green, Irenie Smoker, Kate H. MooreAbstract:Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in Subacute Care. Design: Retrospective analysis of data collected over a 3-month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing Subacute Care in an inpatient setting. Patients: 6773 episodes of Care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthCare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further Care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of Care (rehabilitation: $185.60 [95% Cl, $181-$190] per day for incontinent and $156.82 [95% Cl, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% Cl, $157-$172] for incontinent and $121.40 [95% Cl, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of Care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P
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urinary incontinence in Subacute Care a retrospective analysis of clinical outcomes and costs
The Medical Journal of Australia, 2003Co-Authors: Janette P Green, Irenie Smoker, Kate H. MooreAbstract:Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in Subacute Care. Design: Retrospective analysis of data collected over a 3-month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing Subacute Care in an inpatient setting. Patients: 6773 episodes of Care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthCare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further Care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of Care (rehabilitation: $185.60 [95% Cl, $181-$190] per day for incontinent and $156.82 [95% Cl, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% Cl, $157-$172] for incontinent and $121.40 [95% Cl, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of Care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P<0.01] and motor function for stroke patients [P=0.04]). Conclusion: The relationship between continence status and cost of Care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.
Julie Considine - One of the best experts on this subject based on the ideXlab platform.
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Vital sign abnormalities as predictors of clinical deterioration in Subacute Care patients: A prospective case-time-control study
International journal of nursing studies, 2020Co-Authors: Julie Considine, Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Mari Botti, Maxine Duke, Anastasia F. Hutchison, Tracey BucknallAbstract:ABSTRACT Background Emergency interhospital transfers from inpatient Subacute Care to acute Care occur in 8% to 17.4% of admitted patients and are associated with high rates of acute Care readmission and in-hospital mortality. Serious adverse events in Subacute Care (rapid response team or cardiac arrest team calls) and increased nursing surveillance are the strongest known predictors of emergency interhospital transfer from Subacute to acute Care hospitals. However, the epidemiology of clinical deterioration across sectors of Care, and specifically in Subacute Care is not well understood. Objectives To explore the trajectory of clinical deterioration in patients who did and did not have an emergency interhospital transfer from Subacute to acute Care; and develop an internally validated predictive model to identify the role of vital sign abnormalities in predicting these emergency interhospital transfers. Design This prospective, exploratory cohort study is a subanalysis of data derived from a larger case-time-control study. Setting Twenty-two wards of eight Subacute Care hospitals in five major health services in Victoria, Australia. All Subacute Care hospitals were geographically separate from their health services’ acute Care hospitals. Participants All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management unit to an acute Care hospital within the same health service were included. Patients receiving palliative Care were excluded. Methods Study data were collected between 22 August 2015 and 30 October 2016 by medical record audit. The Cochran-Mantel-Haenszel test and bivariate logistic regression analysis were used to compare cases with controls and to account for health service clustering effect. Results Data were collected on 603 transfers (557 patients) and 1160 controls. Adjusted for health service, ≥2 vital sign abnormalities in Subacute Care (adjusted odds ratio=8.81, 95% confidence intervals:6.36-12.19, p Conclusion Serious adverse events in acute Care should be a key consideration in decisions about the location of Subacute Care delivery. During Subacute Care, 15.7% of cases had vital signs fulfilling organisational rapid response team activation criteria, yet missed rapid response team activations were common suggesting that further consideration of the criteria and strategies to optimise recognition and response to clinical deterioration in Subacute Care are needed.
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Resuscitation status and characteristics and outcomes of patients transferred from Subacute Care to acute Care hospitals: A multi-site prospective cohort study.
Journal of clinical nursing, 2020Co-Authors: Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Mari Botti, Maxine Duke, Tracey Bucknall, Anastasia Hutchinson, Julie ConsidineAbstract:Aims and objectives To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter-hospital transfer from a Subacute to an acute Care hospital. Background Patients who experience emergency inter-hospital transfers from Subacute to acute Care hospitals have high rates of acute Care readmission (81%) and in-hospital mortality (15%). Design This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Methods Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Findings Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute Care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute Care and more likely to return to Subacute Care. Conclusions Two-thirds of patients in Subacute Care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for Subacute Care patients. Relevance to clinical practice As many Subacute Care patients experience clinical deterioration, patient preferences for Care need to be discussed and documented early in the Subacute Care admission.
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timing of emergency interhospital transfers from Subacute to acute Care and patient outcomes a prospective cohort study
International Journal of Nursing Studies, 2019Co-Authors: Julie Considine, Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Maxine Duke, Anastasia F. Hutchison, Tracey Bucknall, Mari BottiAbstract:Abstract Background Australian and international data show that transfer from inpatient rehabilitation to acute Care hospitals occurs in one in ten patients. Early unplanned transfers from Subacute to acute Care hospitals raises questions about the safety of patient transitions between health sectors. Objectives To explore the characteristics of early and late emergency interhospital transfers from Subacute to acute Care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after Subacute Care admission. Design This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study. Setting Twenty-two wards of eight Subacute Care hospitals in five major health services in Victoria, Australia. All Subacute Care hospitals were geographically separate from their health services’ acute Care hospitals. Participants All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute Care hospital within the same health service were included. Patients receiving palliative Care were excluded. Methods Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect. Results There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on Subacute Care admission (median 45 vs 66, p Conclusions The high rates of acute Care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of Care on transfer decisions warrants further investigation.
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characteristics and outcomes of emergency interhospital transfers from Subacute to acute Care for clinical deterioration
International Journal for Quality in Health Care, 2019Co-Authors: Julie Considine, Maryann Street, Helen Rawson, Anastasia F. Hutchison, Tracey BucknallAbstract:Objective: To describe characteristics and outcomes of emergency interhospital transfers from Subacute to acute hospital Care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. Design: Prospective case-time-control study. Setting: Acute and Subacute healthCare facilities from five health services in Victoria, Australia. Participants: Cases were patients with an emergency interhospital transfer from Subacute to acute hospital Care. For every case, two inpatients from the same Subacute Care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. Main outcome measures: Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. Results: Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute Care or Subacute Care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive Care unit admissions and rapid response team calls during their entire hospital admission. Conclusions: Patients who require an emergency interhospital transfer from Subacute to acute hospital Care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute Care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate Subacute Care hospital.
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multisite analysis of the timing and outcomes of unplanned transfers from Subacute to acute Care
Australian Health Review, 2015Co-Authors: Julie Considine, Maryann Street, Mari Botti, Bev Oconnell, Bridie Kent, Trisha DunningAbstract:Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from Subacute to acute Care. Methods Subacute Care in-patients requiring unplanned transfer to an acute Care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of Subacute Care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median Subacute Care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of Subacute Care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01). Conclusions There is a high rate of unplanned transfers to acute Care within 24 h of admission to Subacute Care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute Care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute Care, but still developing in Subacute Care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in Subacute Care facilities. One-third of unplanned transfers occur within 24 h of admission to Subacute Care. Patients who require unplanned transfer from Subacute to acute Care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in Subacute Care require regular physiological assessment and early escalation of Care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to Subacute Care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in Subacute Care settings.
Janette P Green - One of the best experts on this subject based on the ideXlab platform.
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Planning for Subacute Care: predicting demand using acute activity data
Australian health review : a publication of the Australian Hospital Association, 2016Co-Authors: Janette P Green, Jennifer P Mcnamee, Conrad Kobel, Habibur R Seraji, Sj LawrenceAbstract:Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) Care following acute in-patient episodes provided in Australian hospitals. Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre. Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM Care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs. Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning. What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of Subacute Care, it is timely to find improved methods of estimating demand for this type of Care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for Subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions. What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the methodology based on rehabilitation-sensitive AR-DRGs has been extended by updating them to AR-DRG Version 7.0, quantifying the level of 'sensitivity' and incorporating the patient's age to improve the prediction of demand for Subacute services. What are the implications for practitioners? The predictive model takes the form of tables of probabilities that patients will require rehabilitation or GEM Care after an acute episode and can be applied to acute in-patient administrative datasets in any Australian jurisdiction or local area. The use of patient-level characteristics will enable service planners to improve their forecasting of demand for these services. Clinicians and jurisdictional representatives consulted during the project regarded the model favourably and believed that it was an improvement on currently available methods.
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Urinary incontinence in Subacute Care--a retrospective analysis of clinical outcomes and costs.
The Medical journal of Australia, 2003Co-Authors: Janette P Green, Irenie Smoker, Kate H. MooreAbstract:Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in Subacute Care. Design: Retrospective analysis of data collected over a 3-month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing Subacute Care in an inpatient setting. Patients: 6773 episodes of Care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthCare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further Care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of Care (rehabilitation: $185.60 [95% Cl, $181-$190] per day for incontinent and $156.82 [95% Cl, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% Cl, $157-$172] for incontinent and $121.40 [95% Cl, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of Care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P
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urinary incontinence in Subacute Care a retrospective analysis of clinical outcomes and costs
The Medical Journal of Australia, 2003Co-Authors: Janette P Green, Irenie Smoker, Kate H. MooreAbstract:Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in Subacute Care. Design: Retrospective analysis of data collected over a 3-month period in 1996. Setting: 54 medical facilities in Australia and New Zealand providing Subacute Care in an inpatient setting. Patients: 6773 episodes of Care provided to 6455 rehabilitation and geriatric evaluation and management patients. Main outcome measures: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthCare costs. Results: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further Care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of Care (rehabilitation: $185.60 [95% Cl, $181-$190] per day for incontinent and $156.82 [95% Cl, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% Cl, $157-$172] for incontinent and $121.40 [95% Cl, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of Care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P<0.01] and motor function for stroke patients [P=0.04]). Conclusion: The relationship between continence status and cost of Care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.
Trisha Dunning - One of the best experts on this subject based on the ideXlab platform.
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Vital sign abnormalities as predictors of clinical deterioration in Subacute Care patients: A prospective case-time-control study
International journal of nursing studies, 2020Co-Authors: Julie Considine, Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Mari Botti, Maxine Duke, Anastasia F. Hutchison, Tracey BucknallAbstract:ABSTRACT Background Emergency interhospital transfers from inpatient Subacute Care to acute Care occur in 8% to 17.4% of admitted patients and are associated with high rates of acute Care readmission and in-hospital mortality. Serious adverse events in Subacute Care (rapid response team or cardiac arrest team calls) and increased nursing surveillance are the strongest known predictors of emergency interhospital transfer from Subacute to acute Care hospitals. However, the epidemiology of clinical deterioration across sectors of Care, and specifically in Subacute Care is not well understood. Objectives To explore the trajectory of clinical deterioration in patients who did and did not have an emergency interhospital transfer from Subacute to acute Care; and develop an internally validated predictive model to identify the role of vital sign abnormalities in predicting these emergency interhospital transfers. Design This prospective, exploratory cohort study is a subanalysis of data derived from a larger case-time-control study. Setting Twenty-two wards of eight Subacute Care hospitals in five major health services in Victoria, Australia. All Subacute Care hospitals were geographically separate from their health services’ acute Care hospitals. Participants All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management unit to an acute Care hospital within the same health service were included. Patients receiving palliative Care were excluded. Methods Study data were collected between 22 August 2015 and 30 October 2016 by medical record audit. The Cochran-Mantel-Haenszel test and bivariate logistic regression analysis were used to compare cases with controls and to account for health service clustering effect. Results Data were collected on 603 transfers (557 patients) and 1160 controls. Adjusted for health service, ≥2 vital sign abnormalities in Subacute Care (adjusted odds ratio=8.81, 95% confidence intervals:6.36-12.19, p Conclusion Serious adverse events in acute Care should be a key consideration in decisions about the location of Subacute Care delivery. During Subacute Care, 15.7% of cases had vital signs fulfilling organisational rapid response team activation criteria, yet missed rapid response team activations were common suggesting that further consideration of the criteria and strategies to optimise recognition and response to clinical deterioration in Subacute Care are needed.
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Resuscitation status and characteristics and outcomes of patients transferred from Subacute Care to acute Care hospitals: A multi-site prospective cohort study.
Journal of clinical nursing, 2020Co-Authors: Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Mari Botti, Maxine Duke, Tracey Bucknall, Anastasia Hutchinson, Julie ConsidineAbstract:Aims and objectives To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter-hospital transfer from a Subacute to an acute Care hospital. Background Patients who experience emergency inter-hospital transfers from Subacute to acute Care hospitals have high rates of acute Care readmission (81%) and in-hospital mortality (15%). Design This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Methods Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Findings Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute Care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute Care and more likely to return to Subacute Care. Conclusions Two-thirds of patients in Subacute Care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for Subacute Care patients. Relevance to clinical practice As many Subacute Care patients experience clinical deterioration, patient preferences for Care need to be discussed and documented early in the Subacute Care admission.
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timing of emergency interhospital transfers from Subacute to acute Care and patient outcomes a prospective cohort study
International Journal of Nursing Studies, 2019Co-Authors: Julie Considine, Maryann Street, Alison M. Hutchinson, Mohammadreza Mohebbi, Helen Rawson, Trisha Dunning, Maxine Duke, Anastasia F. Hutchison, Tracey Bucknall, Mari BottiAbstract:Abstract Background Australian and international data show that transfer from inpatient rehabilitation to acute Care hospitals occurs in one in ten patients. Early unplanned transfers from Subacute to acute Care hospitals raises questions about the safety of patient transitions between health sectors. Objectives To explore the characteristics of early and late emergency interhospital transfers from Subacute to acute Care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after Subacute Care admission. Design This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study. Setting Twenty-two wards of eight Subacute Care hospitals in five major health services in Victoria, Australia. All Subacute Care hospitals were geographically separate from their health services’ acute Care hospitals. Participants All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute Care hospital within the same health service were included. Patients receiving palliative Care were excluded. Methods Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect. Results There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on Subacute Care admission (median 45 vs 66, p Conclusions The high rates of acute Care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of Care on transfer decisions warrants further investigation.
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multisite analysis of the timing and outcomes of unplanned transfers from Subacute to acute Care
Australian Health Review, 2015Co-Authors: Julie Considine, Maryann Street, Mari Botti, Bev Oconnell, Bridie Kent, Trisha DunningAbstract:Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from Subacute to acute Care. Methods Subacute Care in-patients requiring unplanned transfer to an acute Care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of Subacute Care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median Subacute Care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of Subacute Care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01). Conclusions There is a high rate of unplanned transfers to acute Care within 24 h of admission to Subacute Care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute Care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute Care, but still developing in Subacute Care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in Subacute Care facilities. One-third of unplanned transfers occur within 24 h of admission to Subacute Care. Patients who require unplanned transfer from Subacute to acute Care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in Subacute Care require regular physiological assessment and early escalation of Care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to Subacute Care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in Subacute Care settings.
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Multisite analysis of the timing and outcomes of unplanned transfers from Subacute to acute Care
Australian health review : a publication of the Australian Hospital Association, 2015Co-Authors: Julie Considine, Maryann Street, Mari Botti, Bridie Kent, Bev O'connell, Trisha DunningAbstract:Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from Subacute to acute Care. Methods Subacute Care in-patients requiring unplanned transfer to an acute Care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of Subacute Care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median Subacute Care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of Subacute Care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P
