scholarly journals The Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A Prospective Cohort Study

2012 ◽  
Vol 92 (12) ◽  
pp. 1536-1545 ◽  
Author(s):  
Aaron Thrush ◽  
Melanie Rozek ◽  
Jennifer L. Dekerlegand
Keyword(s):  
Functional Status ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Short Stay ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Inpatient Rehabilitation Facility ◽  
Stay Hospital

Background and Purpose Long-term acute care hospitals (LTACHs) have emerged for patients requiring medical care beyond a short stay. Minimal data have been reported on functional outcomes in this setting. The purposes of this study were: (1) to measure the clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) in an LTACH setting and (2) to explore the association between FSS-ICU score and discharge setting. Participants Data were obtained from 101 patients (median age=70 years, interquartile range [IQR]=61–78; 39% female, 61% male) who were admitted to an LTACH. Participants were categorized into 1 of 5 groups by discharge setting: (1) home (n=14), (2) inpatient rehabilitation facility (n=26), (3) skilled nursing facility (n=23), (4) long-term care/hospice/expired (n=13), or (5) transferred to a short-stay hospital (n=25). Methods Data were prospectively collected from a 38-bed LTACH in the United States over 8 months beginning in September 2010. Functional status was scored using the FSS-ICU within 4 days of admission and every 2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling, supine-to-sit transfers, unsupported sitting, sit-to-stand transfers, and ambulation. Each category was rated from 0 to 7, with a maximum cumulative FSS-ICU score of 35. Results Cumulative FSS-ICU scores significantly improved from a median (IQR) of 9 (3–17) to 14 (5–24) at discharge. Median (IQR) cumulative discharge FSS-ICU scores were significantly different among the discharge categories: home=28 (22–32), inpatient rehabilitation facility=21 (15–24), skilled nursing facility=14 (8–21), long-term care/hospice/expired=5 (0–11), and transfer to a short-stay hospital=4 (0–7). Discussion and Conclusions Patients receiving therapy at an LTACH demonstrate significant improvements from admission to discharge using the FSS-ICU. This outcome tool discriminates among discharge settings and successfully documents functional improvements of patients in an LTACH setting.

Abstract P5: IV Alteplase Benefits Thrombectomy Patients With Incomplete TICI 2 Endovascular Reperfusion but Not Those With Complete TICI 3 Endovascular Reperfusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jason W Tarpley ◽  
Joseph T Ho ◽  
Tamela L Stuchiner ◽  
Renee Ovando ◽  
Daniel Kelly ◽  
...  
Keyword(s):  
Race And Ethnicity ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Iv Tpa

Introduction: There is debate regarding how IV tPA influences the efficacy of Endovascular therapy (EVT). One hypothesized potential benefit of thrombolytics is in patients with incomplete endovascular reperfusion. We compared discharge disposition in EVT patients with TICI 2 or TICI 3 reperfusion who received IV tPA with those who did not. Methods: Data from the Providence System Stroke Registry for acute ischemic stroke patients receiving EVT between January 2015 and May 2020 with a TICI 2 or TICI 3 reperfusion grade were used. Patients presenting later than the conventional 4.5 hour IV tPA window were excluded. Multinomial regressions were used to assess if EVT patients with a TICI 2 or TICI 3 who received IV tPA compared to those who did not receive IV tPA had greater odds of being discharged as expired or hospice or other location (acute care or long term care, skilled nursing facility, left against medical advice), compared to home or inpatient rehabilitation (IRF), adjusting for patient age, sex, race and ethnicity, last known well to arrival, NIHSS at admit, and medical history. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported. Results: Of 419 EVT patients with TICI 2, 50.1% (n=210) received IV tPA and 49.9% (n=209) did not. Of 771 EVT patients with TICI 3, 48.4% (n=373) received IV tPA and 51.6% (n=398) did not. EVT patients with TICI 2 who were not treated with IV tPA were 59% less likely to be discharged as expired or hospice than home or IRF than those treated with IV tPA (AOR=0.414, 95% CI: 0.203, 0.844), and 63% less likely to be discharged somewhere other than home/IRF (AOR=0.372, 95% CI: 0.217, 0.636) than home/IRF. Among EVT patients with TICI 3, multivariate analyses indicated there was no greater likelihood of being discharged expired or to hospice than home/IRF (AOR=0.682, 95%CI: 0.434, 1.07) or discharged somewhere other than home/IRF (AOR=0.839, 95%CI: 0.592, 1.19) between those who received IV tPA and those who did not. Conclusions: Thrombectomy patients with TICI 2 reperfusion had better discharge outcome if they were treated with IV tPA. However, in completely reperfused patients with TICI 3 reperfusion outcome was not affected by prior IV tPA administration.

scholarly journals HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility

2000 ◽  
Vol 77 (2) ◽  
pp. 187-203 ◽  
Author(s):  
Peter A. Selwyn ◽  
Joseph L. Goulet ◽  
Susan Molde ◽  
Janet Constantino ◽  
Kristopher P. Fennie ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

scholarly journals Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020

2020 ◽  
Vol 69 (13) ◽  
pp. 377-381 ◽  
Author(s):  
Anne Kimball ◽  
Kelly M. Hatfield ◽  
Melissa Arons ◽  
Allison James ◽  
Joanne Taylor ◽  
...  
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
King County ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing

The recreation therapist versus the certified activity director: Which professional receives fewer deficiencies in long-term care facilities?

2010 ◽  
Vol 9 (1) ◽  
pp. 9-14
Author(s):  
Timothy J. Legg, PhD, CNHA, GNP-BC, FACHCA ◽  
Sharon A. Nazarchuk, PhD, MHA, RN ◽  
Deborah Adelman, PhD, RN, CNS
Keyword(s):  
Long Term Care ◽  
Skilled Nursing Facility ◽  
Therapeutic Recreation ◽  
Professional Group ◽  
Recreation Therapy ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Care Facilities

The literature reports no studies that sought to determine which professional group (certified therapeutic recreation therapist versus certified activity director) achieves fewer survey deficiencies in the skilled nursing facility. This article will examine the scant and dated literature that is available to demonstrate which of these activity professionals has superior outcomes specific to the OBRA ’87 requirements. The article concludes with an articulation of the need for the discipline of recreation therapy to involve itself in outcomes research specific to which of the two disciplines better achieves the objectives of OBRA ’87.

scholarly journals Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility

2020 ◽  
Vol 71 (11) ◽  
pp. e718-e725 ◽  
Author(s):  
Massimo Pacilli ◽  
Janna L Kerins ◽  
Whitney J Clegg ◽  
Kelly A Walblay ◽  
Hira Adil ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Lessons Learned ◽  
Candida Auris ◽  
Public Health Response ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
High Acuity

Abstract Background Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.

Evaluation of Hypertensive Therapy in a Skilled Nursing Facility

1983 ◽  
Vol 17 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Peter P. Lamy ◽  
Ginette Lapierre ◽  
M. Peter Pevonka ◽  
Ronald B. Stewart ◽  
Richard L. Yost
Keyword(s):  
Antihypertensive Therapy ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Cerebrovascular Diseases ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Diastolic Hypertension ◽  
Hypertensive Therapy

Treatment of hypertension in the elderly has recently received increased attention. Both systolic and systolic plus diastolic hypertension are risk factors for cardiovascular and cerebrovascular diseases in patients older than age 65, but the value of antihypertensive therapy in reducing morbidity and mortality has not been adequately studied. The authors evaluated the appropriateness of antihypertensive therapy prescribed for elderly patients in a skilled nursing home and determined the effect reductions in antihypertensive therapy had upon the function and mental status of these patients. Of the 120 patients surveyed, 26.7 percent were found to have a diagnosis of hypertension, and 1/3 of these patients were not receiving any medications at the time of the study. Assessment of the remaining treated patients resulted in a recommendation to alter therapy in 43 percent of the cases. Results from this study suggest that periodic assessment of antihypertensive therapy in long-term care facilities should be considered.

Ethical Challenges for Speech-Language Pathologists in the Long-Term Care Setting

2011 ◽  
Vol 16 (1) ◽  
pp. 3-9
Author(s):  
John D. Tonkovich
Keyword(s):  
Code Of Ethics ◽  
Skilled Nursing Facility ◽  
Ethical Challenges ◽  
Health Care Environment ◽  
Nursing Facility ◽  
Term Care ◽  
Care Environment ◽  
Skilled Nursing ◽  
Course Of Action

Clinicians can use American Speech-Language-Hearing Association's Code of Ethics (2010) to help them determine the best course of action in situations that they face across various settings. This article will consider several specific challenges that clinicians face in the long-term setting and will reference the Code of Ethics to assist in navigating the skilled nursing facility (SNF) health-care environment and as a guide for dealing with anticipated change.

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