Long Stay Patients in Winnipeg Acute Care Hospitals

Kozyrskyj, Anita L.; Coster, Carolyn De; John, P. S.

doi:10.1016/s0840-4704(10)60177-9

Cited by 10 publications

(14 citation statements)

References 23 publications

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“…This result is in agreement with other studies which found that patients with functional dependency, those requiring more assistance with their ADL, and patients with physical limitations were more at risk of experiencing delays in hospital discharge and remaining on acute care wards for non-acute reasons. 18,20,24 Third, along with several studies that showed older patients being at increased risk of experiencing hospital discharge delays, 11,18,19,[21][22][23] our results confirm that older age is a risk factor for remaining on an acute care ward for non-acute reasons. We observed only a 2% increased risk in a study population in which 53% were aged 75 years.…”

Section: Resultssupporting

confidence: 86%

“…The factor that decreased the risk of being non-acute was having a feeding tube prior to hospital presentation (OR 0.50, 95% CI 0.31-0.83). 4,19,22,24 The multivariate model identified seven variables that are significantly associated with the non-acute status on day 30 of hospitalization. First, we found that cognitive impairment increases the likelihood of occupying an acute care bed for non-acute purposes by 61%.…”

Section: Resultsmentioning

confidence: 99%

“…11 More importantly, over and above the fact that severely ill patients often require prolonged hospitalization, these long-stay patients are also at greater risk of remaining in hospital for inappropriate reasons. 4,24 The main objective of this study was to determine patient pre-hospitalization factors and factors present on admission that are associated with the risk of occupying an acute care bed for non-acute reasons at the 30 th day of hospitalization. …”

Section: Introductionmentioning

confidence: 99%

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Hospital stay on acute care units for non-acute reasons

Afilalo

Soucy

Xue

et al. 2015

Healthc Manage Forum

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This study identifies patient risk factors present prior to an acute hospitalization that are associated with occupying acute care beds for non-acute reasons on the 30 day of a hospitalization. Data from 952 adult patients were obtained, among which 333 (35%) were evaluated as non-acute on their 30 day. Inability to move in and out of the bed, cognitive impairment, receiving home or community healthcare services prior to hospitalization, unavailable family resources, a secondary diagnosis within the mental and behavioural category, and age ≥75 years were found to increase the risk of occupying acute care beds for non-acute reasons, while patients with a feeding tube were less likely to be non-acute at day 30.

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Section: Resultssupporting

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospital stay on acute care units for non-acute reasons

Afilalo

Soucy

Xue

et al. 2015

Healthc Manage Forum

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“…50 This characteristic has been found to be associated with longer hospitalization. 51,52 Cognitively impaired patients remaining on an acute psychiatric care unit present a major concern, mainly because these settings are often unable to adequately meet these patients' needs. 53,54 Finally, 8 patients in the nonacute group had a total hospital LOS of greater than 100 days, with 1 patient staying as long as 153 days.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions:Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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“…6,20 That said, ALC is a symptom of a poorly functioning healthcare system, 20 characterized by hospital process issues (delays in assessment or lack of consensus on next steps in care), [21][22][23] postacute care capacity issues (lack of timely and suitable housing, rehabilitation and home care services) 5,[23][24][25][26][27][28][29] or lack of long-term care beds (particularly beds that are tailored to the linguistic, cultural and geographical preferences of patients and caregivers). [30][31][32][33] Simply put, the ALC problem represents a mismatch between available care services and the needs of patients and their caregivers. The few studies on patient and caregiver ALC experience report that patients and caregivers feel overwhelmed, confused, excluded from care conversations and concerned about the next steps in the patient's care.…”

Section: Backg Rou N Dmentioning

confidence: 99%

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

Kuluski

Cadel

et al. 2020

Health Expectations

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Objective To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences. Design This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention. Setting and Participants Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research. Results Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement. Discussion and Conclusions Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.

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Long Stay Patients in Winnipeg Acute Care Hospitals

Cited by 10 publications

References 23 publications

Hospital stay on acute care units for non-acute reasons

Hospital stay on acute care units for non-acute reasons

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

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