Long-term acute care hospitals

Medical care providers in acute care hospitals, long-term care facilities, outpatient clinics, and home health agencies... 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

The JCAHO has identified pain management as an import focus for accreditation visits starting in 2000 and 2001. Standards have been developed for ambulatory care, behavioral health care, home care, health care networks, hospitals, long-term care, and long-term care pharmacies.These new standards should help improve acute pain management in these settings. 

Munoz-Price LS, Hota B, Sterner A, Weinstein RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009 30(11) 1031-5. 

Campbell S. HCFA clamping down on long term acute care hospitals within hospitals . Health Care Strateg Manage 1997 15(8) 12-13. 

Frequency determined by the intensity of patient care. As patients move through the care continuum (Fig. 2), multidisciplinary rounds decrease in frequency from daily (or twice daily) in the ICU and step-down units to weekly in the long-term acute care hospital (LTACH) (although physician visit is required daily) and skilled nursing facility and to a frequency that resembles outpatient follow-up after discharge with HMV. 

Figure 1 The management of respiratory failure in the United States. Many patients are admitted initially to an acute care hospital. If they wean ptomptiy, they may spend time in an LTAC hospital for rehabilitation, and eventually return home. If they fail to wean, they undergo tracheostomy and are transferred to an LTAC when stable. Weaning attempts continue, and a mincnity of patients return home the rest remain at the LTAC or are transferred to a SNF. Patients who deteriorate while at LTACs or at home return to the acute care hospital fOT stabilization. Some patients with chronic respiratory failure do not require acute care but are ventilated noninvasively and remain home. Abbreviations COPD, chronic obstructive pulmonary disease NIV, noninvasive ventilation LTAC, long-term acute care SNF, skilled nursing facility.

Deaths per 1000 patients having developed specified complications of care dniing hospitalization. Excludes patients age 75 and older, neonates in MDC 15, patients admitted from long-term care facility and patients transferred to or from other acute care facility... 

In the United States, the growing influence of capitated care has driven the development of alternative care sites for a VAI. By 1997, there were 200 long-term acute care (LTAC) hospitals nationwide, with a capacity for 15,000 patients (13). The presence of intermediate and long-term facilities in Europe for the management of a VAI varies in different jurisdictions. In France, a well-developed system of care includes extended care facilities, which provide long-term care for VAIs or respite care for patients whose families need relief Irom... 

Long-term acute care (LTAC) hospitals are for patients who need less intensive monitoring and intervention than ICU patients, but require treatment that is too complex for... 

The patient s medical and social requirements should be considered in the light of the actual home conditions, caregiver s attitude and training, distance from the hospital, and availability of technical resources. The team must make a therapeutic alliance with the patient and caregivers if HMV is to be successful, especially in more severely dependent patients. Alternatives to home, such as hospice, long-term care facility, or nursing home can be helpful, whether for a transitional move or for a permanent placement. The aim is to ensure the highest possible level of independence rather than create an acute care environment in the patient s home. 

The 1960s witnessed the continued support of some polio patients at home, as well as the introduction of mouthpiece ventilation for long term, even continuous, support at some specialized rehabilitation hospitals (4). The 1960s also ushered in intensive care units (ICUs) that served as specialized centers to treat patients with acute respiratory failure. Sophisticated mechanical ventilators were developed to treat these patients. Some of whom failed to wean and often spent weeks or months in these units because no other facilities were available to adequately care for them. 

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