Journal of the American Medical Directors Association
-
Nursing home (NH) residents experience frequent hospital transfers, some potentially avoidable. The objective of this report is to describe a replication of the Interventions to Reduce Acute Care Transfers program among member facilities of a New York City area NH provider association (INTERACT NY) and estimate its effect on hospital transfers. ⋯ INTERACT NY, a novel collaborative training program, resulted in good uptake of the INTERACT tools and processes among its member nursing homes. Changes in hospitalization rates associated with INTERACT NY were similar to those observed in previous implementations of INTERACT. The program addresses a growing interest in reducing potentially preventable hospital admissions among nursing home residents and providing alternatives to hospital care through standardized approaches to communication, early identification of clinical issues, decision-support, and support for partnerships between acute and post-acute care providers.
-
Delayed surgery (ie, >48 hours from arrival in hospital) and pre-fracture disability are thought to be long-term risk factors for mortality in patients with hip fracture (HF). However, the combined effect on mortality of these two conditions has not been satisfactorily assessed in previous studies. ⋯ Patients with both pre-fracture disability and delayed HF surgical treatment had a nearly six-fold increased 12-month mortality risk than did patients with neither disability nor delayed surgery.
-
Comparative Study
The evaluation of an interdisciplinary pain protocol in long term care.
To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents. ⋯ These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents.
-
Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. ⋯ Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards, especially in the cognitively impaired patients.