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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Improving disposition outcomes for patients in a geriatric skilled nursing facility
Randi E Berkowitz1, Richard N Jones, Ron Rieder
1Hebrew SeniorLife, Boston, Massachusetts, USA. rberkowitz@hsl.harvard.edu
Journal of the American Geriatrics Society
|June 9, 2011
Summary
Implementing targeted interventions in skilled nursing units (SNUs) significantly improved patient discharge dispositions, reducing acute care transfers and increasing in-unit deaths aligned with patient wishes.
Area of Science:
- Gerontology
- Health Services Research
- Palliative Care
Background:
- Skilled nursing units (SNUs) play a crucial role in post-acute care.
- Improving discharge disposition is essential for patient outcomes and healthcare efficiency.
- Reducing unnecessary hospital transfers from SNUs is a key objective.
Purpose of the Study:
- To evaluate the effectiveness of a multifaceted intervention designed to enhance discharge disposition from a skilled nursing unit.
- To assess the impact of standardized admission procedures, palliative care consultations, and root-cause analysis conferences on patient outcomes.
Main Methods:
- A historical control design was employed, comparing discharge data before and after intervention implementation.
- The study included 1,725 patients admitted to a 50-bed SNU between June 2008 and May 2010.
- Interventions included standardized physician admission templates, palliative care consultations for high-readmission patients, and bimonthly multidisciplinary conferences.
Main Results:
- Discharge dispositions showed a statistically significant difference between the pre- and post-intervention periods (P=.03).
- Acute care readmissions decreased by nearly 20% (from 16.5% to 13.3%).
- Patients were more likely to die in the SNU, per their wishes, than to be transferred to acute care (OR=2.45).
Conclusions:
- The implemented interventions effectively reduced hospital transfers from SNUs.
- Multifaceted quality improvement strategies can positively influence discharge planning and patient-centered care in SNUs.
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