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Management of Acute Changes in Condition in Skilled Nursing Facilities.

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Title: Management of Acute Changes in Condition in Skilled Nursing Facilities.
Authors: Ouslander, Joseph G., Engstrom, Gabriella, Reyes, Bernardo, Tappen, Ruth, Rojido, Carolina, Gray‐Miceli, Deanna
Source: Journal of the American Geriatrics Society. Dec2018, Vol. 66 Issue 12, p2259-2266. 8p. 3 Charts, 2 Graphs.
Subjects: Nursing care facilities, Critical care medicine, Dyspnea, Hemorrhage, Hospital admission & discharge, Hospital emergency services, Medical appointments, Psychosocial factors, Social support, Human services programs
Abstract: OBJECTIVES To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations. DESIGN Secondary analysis of data from a randomized controlled trial involving 264 SNFs. PARTICIPANTS One hundred thirty‐three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group. INTERVENTIONS During a 12‐month period, intervention SNFs received training and support for implementation of the Interventions to Reduce Acute Care Transfers program. Control SNFs were offered training and implementation support after the end of the 12‐month trial. MEASURES Project champions used a structured online tool to describe acute changes in condition that did not result in a hospital transfer within 72 hours of the change. RESULTS: Most of the 7,689 episodes of acute change in condition reported involved multiple changes that were not disease specific. Ten percent resulted in hospital transfer between 72 hours and 7 days after the change. Five acute changes had odds ratios for transfer greater than 2 (mental status change, abnormal vital signs, bleeding, shortness of breath, and unresponsiveness). Most transfers were for reasons other than the initial change in condition. CONCLUSIONS: A wide variety of acute changes in condition can be managed in SNFs without hospital transfer. Most of these changes are nonspecific and multiple, and when they are associated with hospital transfer, the reasons for the transfer are most often different from the initial acute change in condition. These data highlight the multifactorial nature of acute changes in condition in the SNF population and suggest that disease‐specific protocols and assessment tools may not be the most appropriate approach to managing acute changes in condition in the SNF setting. J Am Geriatr Soc 66:2259–2266, 2018. See related editorial by Kathleen Unroe. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Management of Acute Changes in Condition in Skilled Nursing Facilities.
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  Data: <searchLink fieldCode="AR" term="%22Ouslander%2C+Joseph+G%2E%22">Ouslander, Joseph G.</searchLink><br /><searchLink fieldCode="AR" term="%22Engstrom%2C+Gabriella%22">Engstrom, Gabriella</searchLink><br /><searchLink fieldCode="AR" term="%22Reyes%2C+Bernardo%22">Reyes, Bernardo</searchLink><br /><searchLink fieldCode="AR" term="%22Tappen%2C+Ruth%22">Tappen, Ruth</searchLink><br /><searchLink fieldCode="AR" term="%22Rojido%2C+Carolina%22">Rojido, Carolina</searchLink><br /><searchLink fieldCode="AR" term="%22Gray‐Miceli%2C+Deanna%22">Gray‐Miceli, Deanna</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Dec2018, Vol. 66 Issue 12, p2259-2266. 8p. 3 Charts, 2 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Nursing+care+facilities%22">Nursing care facilities</searchLink><br /><searchLink fieldCode="DE" term="%22Critical+care+medicine%22">Critical care medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Dyspnea%22">Dyspnea</searchLink><br /><searchLink fieldCode="DE" term="%22Hemorrhage%22">Hemorrhage</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+admission+%26+discharge%22">Hospital admission & discharge</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+emergency+services%22">Hospital emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+appointments%22">Medical appointments</searchLink><br /><searchLink fieldCode="DE" term="%22Psychosocial+factors%22">Psychosocial factors</searchLink><br /><searchLink fieldCode="DE" term="%22Social+support%22">Social support</searchLink><br /><searchLink fieldCode="DE" term="%22Human+services+programs%22">Human services programs</searchLink>
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  Data: OBJECTIVES To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations. DESIGN Secondary analysis of data from a randomized controlled trial involving 264 SNFs. PARTICIPANTS One hundred thirty‐three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group. INTERVENTIONS During a 12‐month period, intervention SNFs received training and support for implementation of the Interventions to Reduce Acute Care Transfers program. Control SNFs were offered training and implementation support after the end of the 12‐month trial. MEASURES Project champions used a structured online tool to describe acute changes in condition that did not result in a hospital transfer within 72 hours of the change. RESULTS: Most of the 7,689 episodes of acute change in condition reported involved multiple changes that were not disease specific. Ten percent resulted in hospital transfer between 72 hours and 7 days after the change. Five acute changes had odds ratios for transfer greater than 2 (mental status change, abnormal vital signs, bleeding, shortness of breath, and unresponsiveness). Most transfers were for reasons other than the initial change in condition. CONCLUSIONS: A wide variety of acute changes in condition can be managed in SNFs without hospital transfer. Most of these changes are nonspecific and multiple, and when they are associated with hospital transfer, the reasons for the transfer are most often different from the initial acute change in condition. These data highlight the multifactorial nature of acute changes in condition in the SNF population and suggest that disease‐specific protocols and assessment tools may not be the most appropriate approach to managing acute changes in condition in the SNF setting. J Am Geriatr Soc 66:2259–2266, 2018. See related editorial by Kathleen Unroe. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Group: Ab
  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=133464557
RecordInfo BibRecord:
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        Value: 10.1111/jgs.15632
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      – Code: eng
        Text: English
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        PageCount: 8
        StartPage: 2259
    Subjects:
      – SubjectFull: Nursing care facilities
        Type: general
      – SubjectFull: Critical care medicine
        Type: general
      – SubjectFull: Dyspnea
        Type: general
      – SubjectFull: Hemorrhage
        Type: general
      – SubjectFull: Hospital admission & discharge
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      – SubjectFull: Hospital emergency services
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      – SubjectFull: Medical appointments
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      – SubjectFull: Psychosocial factors
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      – SubjectFull: Social support
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      – SubjectFull: Human services programs
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      – TitleFull: Management of Acute Changes in Condition in Skilled Nursing Facilities.
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              M: 12
              Text: Dec2018
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              Y: 2018
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