Transferring Nursing Home Residents to Acute Care Hospital–To Do or Not To Do, That is the Question

2010 ◽  
Vol 11 (5) ◽  
pp. 304-305 ◽  
Author(s):  
Roger Y. Wong
Keyword(s):  
Nursing Home ◽  
Acute Care ◽  
Nursing Home Residents ◽  
Acute Care Hospital ◽  
Care Hospital

Validation of the STRATIFY falls risk-assessment tool for acute-care hospital patients and nursing home residents: study protocol

2015 ◽  
Vol 71 (8) ◽  
pp. 1948-1957 ◽  
Author(s):  
Marta Aranda-Gallardo ◽  
Margarita Enriquez de Luna-Rodriguez ◽  
Jose Carlos Canca-Sanchez ◽  
Ana Belen Moya-Suarez ◽  
Jose Miguel Morales-Asencio
Keyword(s):  
Risk Assessment ◽  
Nursing Home ◽  
Acute Care ◽  
Study Protocol ◽  
Assessment Tool ◽  
Nursing Home Residents ◽  
Acute Care Hospital ◽  
Risk Assessment Tool ◽  
Care Hospital ◽  
Hospital Patients

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

2021 ◽  
pp. 088506662110144
Author(s):  
Sainfer Aliyu ◽  
Kevin McGowan ◽  
Dilbi Hussain ◽  
Lama Kanawati ◽  
Maria Ruiz ◽  
...  
Keyword(s):  
Nursing Home ◽  
Acute Care ◽  
Academic Medical Center ◽  
Nursing Home Residents ◽  
Resistant Organism ◽  
Care Hospital ◽  
Drug Resistant ◽  
Gram Positive ◽  
Gram Negative ◽  
The Impact

Objective: The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. Design: Retrospective cohort study Setting: 960 bed tertiary academic medical center Patients: Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. Interventions: Retrospective analysis of prevalence and outcomes. Measurements and Main Results: Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). Conclusion: Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.

scholarly journals 2369. Prescribing Choices and C. difficile Infection Risk: A Longitudinal Cohort Study of Nursing Home Residents in Ontario, Canada

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S817-S817
Author(s):  
Kevin Antoine. Brown ◽  
Kevin Schwartz ◽  
Bradley Langford ◽  
Christina Diong ◽  
Gary Garber ◽  
...  
Keyword(s):  
Cohort Study ◽  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents ◽  
Acute Care Hospital ◽  
Low Risk ◽  
Drug Benefit ◽  
World Population ◽  
Adjusted Relative Risk ◽  
Care Hospital

Abstract Background Antibiotics are the primary modifiable risk factor for C. difficile infection (CDI). However, the comparative risks of different prescribing choices are not known. Our objective was to quantify the benefits of: (1) preventing antibiotic initiation, (2) substituting high-risk antibiotics for low-risk antibiotics, (3) reducing antibiotic duration. Methods We conducted a cohort study of residents of over 600 Ontario nursing homes in the 2014 to 2017 period. All non-acute care hospital antibiotic exposures were identified from the Ontario Drug Benefit database, while CDI was identified using outpatient billings and/or hospital ICD-10 codes. Logistic regression models were used to examine the risk of CDI as a function of time-varying antibiotic exposures, while controlling for 14 different risk factors. Based on the models, we estimated the comparative risks of specific antibiotic regimens. Results We identified 1,944 cases of CDI, for an incidence of 1.60 per 100,000 person-days. The 90-day risk among residents without antibiotics was 0.84 per 1,000 residents (‰), compared with 1.85‰ in those with a 7-day course of antibiotics. Preventing a 7-day course reduced CDI risk by 45% (see table, adjusted relative risk [RR] = 0.55, 95% confidence interval [CI] = 0.50, 0.60). The antibiotics conferring the highest risks were clindamycin at 4.1‰, moxifloxacin at 3.2‰, and amoxiclav at 3.0‰. Comparing 7-day courses of antibiotics with similar indications: nitrofurantoin engendered 37% less risk than ciprofloxacin, amoxicillin resulted in 31% less risk than amoxicillin-clavulanate, and cephalexin had 51% less risk than clindamycin. Reduced antibiotic durations were associated with less C. difficile risk. Compared with a 10-day course, a 7-day course was associated with 12% less risk, while a 5-day course was associated with 21% less risk. Conclusion We have quantified, using a real-world population-based cohort of nursing home residents, the reduction in CDI risk incurred by preventing unnecessary antibiotic initiations, preferring low-risk agents over high-risk agents, and reducing duration. These figures will help clinicians compare risks and benefits of different prescribing choices with regards to CDI prevention. Disclosures All authors: No reported disclosures.

Duration of Stay and other Aspects of Nursing Home Use

1981 ◽  
Vol 12 (4) ◽  
pp. 301-312 ◽  
Author(s):  
Leticia Vicente ◽  
James A. Wiley ◽  
R. Allen Carrington
Keyword(s):  
Nursing Home ◽  
Acute Care ◽  
Human Population ◽  
Acute Care Hospital ◽  
Residential Facility ◽  
Care Hospital ◽  
Alameda County ◽  
Department Of Health ◽  
First Admission

In 1965, the Human Population Laboratory (California State Department of Health Services) conducted a survey of the non-institutionalized population of Alameda County. Subsequent checking of death records disclosed that 521 survey participants aged fifty-five years or over in 1965 had died by January, 1975. A follow-up in 1977–78 of nursing home experience among these decedents revealed that about two-fifths of those for whom information could be obtained (N = 455) had entered a nursing home at least once in the nine-year follow-up period. Further inquiry located 158 cases whose experience of institutionalization before their death could be reconstructed. Among these cases, only 22 per cent ever returned home or transferred to a residential facility after being institutionalized. Most persons died after the first admission, at the nursing home itself or at an acute care hospital to which they had been transferred shortly before death. Among the cases whose experience of institutionalization could be reconstructed, five out of ten spent less than three months, and six out of ten spent less than six months, as patients in nursing home(s). However, nearly 30 per cent of the 158 cases with reconstructed histories accumulated patient-days exceeding a year.

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