Patients discharged to long term-acute care hospitals (LTACH) following critical illness have high rates (20–34%)of acute hospital readmission. We have previously shown an increasing frequency of acute medical transfer (AMT), including within 72 hours of admission. This investigation characterizes AMT in complex respiratory patients.
Admission, discharge, case mix index (CMI)(measure of medical complexity),length of stay (LOS)and outcomes for all respiratory patients from 3 affiliated LTACH units undergoing AMT over 3 years was analyzed. Referring hospital type (teaching/community) and primary LTACH service (teaching/private practice) were recorded. Total discharges and AMT were obtained. Stastical analysis was performed using SAS (ver. 9.1, SAS Cary, NC).
5486 discharges and 1205 AMT occurred during the study period. Of these, 526 (44%) were admitted to the LTACH with a respiratory diagnosis, and 305(57%) required mechanical ventilation. Mean age was 70 +/−12 years; 49.6% were female. AMT occurred after an LOS (days) of 0–1, 2–3, 4–30 and > 31 in 34(6%), 66 (13%), 299 (57 %)and 127 (24 %) patients respectively. AMT was more likely to occur later in the work week. Diagnoses reulting in AMT included acute respiratory (36%), cardiac (13%), gastrointestinal (18%), infectious (12%) or neurologic (10%) and were unrelated to LOS. CMI values increased in patients with longer LOS before AMT (p<.001). AMT was unrelated to either type of referring acute facility or primary medical LTACH service. Most patients (310, 58%) returned to the LTACH following AMT, while 132 (25%) died during the acute illness.
Patients with complex respiratory illness have high rates of AMT often within 72 hours of admission to the LTACH. Respiratory complications frequently cause AMT. AMT is more likely to occur on weekend shifts. Many patients are admitted to multiple facilities during their acute and LTACH hospitalizations.
Patients with complex respiratory illness have a significant risk of AMT following admission to an LTACH. Risk factors for AMT need to be identified and strategies developed to reduce AMT in this patient population.
Katherine Hendra, No Financial Disclosure Information; No Product/Research Disclosure Information