Elderly Heart Failure Patients Who Need Skilled Nursing Care Often Sicker

Reposted from http://www.redorbit.com

Elderly patients with heart failure who need skilled nursing care after hospital discharge are often sicker, at higher risk for poor outcomes and are more likely than other patients to die or be rehospitalized within one year, according to research reported in Circulation: Heart Failure, an American Heart Association journal.

“Patients hospitalized with heart failure are high risk to start with,” said Larry A. Allen, M.D., M.H.S., lead author of the study and assistant professor of cardiology at the University of Colorado-Denver School of Medicine in Aurora. “If they have to go to a skilled nursing facility, patients, families and providers shouldn’t be under the impression that life will, necessarily, go back to normal. We should help patients and their families recognize this high risk and adjust their medical decision making appropriately.”

Heart failure affects nearly 6 million Americans, and is the primary cause of hospitalizations among Medicare patients. Although many of these patients are discharged to skilled nursing facilities, the type of treatment they receive often varies.

A skilled nursing facility is similar to a nursing home, but can also provide specialized care, such as physical therapy, for patients unable to resume independent living. Skilled nursing patients may by nature face extra challenges, including less mobility, cognitive impairment or poor in-home support ― all of which are determinants to outcomes.
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“We don’t have a lot of data about the quality of care given in these facilities,” Allen said. “This analysis highlights the need to better understand this unique group of patients and the care they receive.

Are they and their families getting information they need to make informed decisions on alternatives to care for short- and long-term prognosis?”

Allen and colleagues analyzed data on 15,459 Medicare patients ― enrolled in the American Heart Association’s Get With The Guidelines®-Heart Failure program at 149 hospitals in 2005 and 2006 ― and discharged from the hospital after three or more days of heart failure treatment. Patients’ average age was 80, most were white and 55 percent were female. The researchers found that:

* About one-fourth of patients were discharged to a skilled nursing facility.
* Thirty days post-discharge, 14 percent of patients discharged to skilled nursing facilities had died of any cause, compared to 4 percent of those who returned home from the hospital.
* At one year, 54 percent of patients discharged to skilled nursing facilities had died of any cause, compared to 29 percent of patients discharged to home.

Furthermore, there was a higher rehospitalization rate among patients discharged to skilled nursing facilities. Thirty days after initial hospital discharge, 27 percent of patients discharged to skilled nursing facilities were rehospitalized for any cause, compared to 24 percent of patients discharged to home. One year after discharge, rehospitalizations were common in both groups, although the difference between them remained steady, with 76 percent of skilled nursing and 72 percent of home patients readmitted to the hospital.

Patients discharged to skilled nursing facilities were more likely than other patients to be older, female, hospitalized longer and to have other complications in addition to heart failure.

“Even after adjusting for patient differences, a strong predictor of mortality in the next year was discharge to a skilled nursing facility,” Allen said. “This has important implications for talking to patients and their families during the initial hospitalization for heart failure.

They need to have clear expectations for survival and rehospitalization. Options for advanced therapies and end-of-life care, including hospice and advanced directives, should be discussed for these high-risk patients.”

Skilled nursing use varied by region. The highest rate was in the northeastern United States, where nearly one-third of heart-failure patients left the hospital for skilled nursing facilities. The lowest was in the west, where about one-fourth required this type of care.

Reposted from www.redorbit.com

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Digital Nursing

Digital nursing  | ajcjobs.com.

Consultant uses social media, the Web to share expertise

By Laura Raines
For AJC Jobs

In 35 years as a clinical care nurse, Barbara McLean has never lost her focus on improving bedside nursing. Thanks to Internet technology and social media, McLean’s bedside reach is now global.

Barry Williams, Special Barbara McLean looks at her website. McLean uses podcasts, Facebook and other social media to communicate with the medical staff at the hospital she volunteers with in Haiti.

“I always wanted to mentor and inspire others to higher levels of practice,” said McLean, MN, RN, CCRN, CCNS, CRNP, FCCM.

At 58, this independent critical care practice consultant uses an interactive website, podcasts, Facebook and Twitter to inform and educate a worldwide nursing audience.

“I saw, early in my career, that hospitals didn’t always have the experts they needed in house to take practice to a higher level,” McLean said. “I was fortunate to have a gift for public speaking and to possess the ability to put complex issues in a form that people can understand.”

In 1985, she began her consulting practice by teaching in hospitals, publishing her research and lecturing at conferences. She’s given more than 2,000 national and international presentations on evidence-based, critical-care topics such as patient safety, quality care, sepsis, ventilation and tissue oxygenation.

Her work with Piedmont Health System’s staff to reduce mortality in sepsis patients resulted in the award-winning McLean Piedmont Stop Sepsis algorithm. The project reduced sepsis mortality in the Piedmont System by 30 percent starting in 2008, and has been adopted by other hospitals.

About eight years ago, McLean developed a website to deliver continuing education to nurses through webinars and podcasts. Her goal was to create a library with lectures on best practices that nurses can download and instantly put to use.

Keeping up with best practices “is just one of the reasons that nurses need to stay at least minimally abreast of all that’s happening with virtual technology,” McLean said. “These are powerful tools we can use.”

Read the full story here!  Digital nursing  | ajcjobs.com.