PURPOSE: Patients discharged to long term acute care (LTAC) facilities following critical illness have reported short stay acute hospital (SSAH) readmission rates of 20–34%. These unplanned acute medical transfers (UAMT) are usually for urgent medical care not available at the LTAC. This investigation characterizes UAMT in two LTAC populations.
METHODS: One thousand UAMT were identified from all discharges for a 150-bed LTAC between 2004–2006. Information on UAMT diagnosis, duration of LTAC admission prior to UAMT, day of the week of UAMT and SSAH discharge patient disposition following UAMT was collected. Similar information for 144 UAMT during 2005 from a second LTAC is also reported.
RESULTS: From 2004–2006, the percent discharges that were UAMT and percent of all UAMT occuring within 72 hours after LTAC admission both increased (16% to 22%, p=.02 and 19% to 26%, p=.048, respectively). Forty-two percent of UAMT occured on weekends. Frequent UAMT causes were acute respiratory (24%), gastrointestinal (19%) or infectious disease (19%) illness. From 2004–2006 more patients had an acute GI process prompting UAMT (17% to 21%). Most patients (57%) returned to the LTAC, however 21% died during acute admission. In the second LTAC 18% of all UAMT occured within 72 hours of admission, 50% occured on weekends and acute respiratory distress was the most frequent UAMT diagnosis.
CONCLUSION: In our LTAC populations, UAMT occured more frequently during shifts with less staffing and most often were caused by respiratory distress. From 2004–2006, overall UAMT and UAMT soon after LTAC admission have increased. Potential causes include earlier SSAH disharge, higher patient acuity and changing patient demographics. Physician skill level, liability concerns and unclear advance directives may also lead to UAMT. Future investigations will be directed at determining factors contributing to UAMT.
CLINICAL IMPLICATIONS: This initial investigation describes patient and LTAC factors associated with UAMT. These transfers may result in medical error, interuption of the rehabilitation process, decreased patient/family confidence in the LTAC and increased costs.
DISCLOSURE: Katherine Hendra, No Financial Disclosure Information; No Product/Research Disclosure Information