Select Specialty Hospital-Macomb, Michigan
Linda and David Kubert
Kessler Institute for Rehabilitation, New Jersey
Select Specialty Hospital-Augusta, Georgia
Select Specialty Hospital-Phoenix, Arizona
Courtney King Dye
A major outcome for many long-term acute care hospital (LTACH) patients is successful liberation - or weaning - from mechanical ventilation. Select Medical's Pulmonary / Ventilator Program provides specialized care for patients with acute or chronic respiratory disorders who may need ventilator weaning or require extensive respiratory treatments to breathe independently. Approximately 20 percent of our LTACH patients are on mechanical ventilation. Select Medical has had a high success rate for weaning patients off of the ventilator. Approximately 70 percent of patients who failed weaning during their stay in a traditional hospital setting have been successfully weaned off of the ventilator in Select Medical LTACHs.
Patient outcomes serve as one important set of measures regarding the quality of our care and services. Similarly, the satisfaction of our patients is a key indicator of how well we meet their acute care needs and individual goals. Select Medical measures the satisfaction of patients and families following their LTACH stay using the Select Medical Patient Perception of Care survey. Our overall patient satisfaction trend shows a very consistent, high proportion of positive responses from patients and families. The overall average LTACH positive raw score percentage, since the first quarter of 2011, has been 92 percent or higher. (Note that the satisfaction survey return rate is approximately 50 percent).
Many of our patients arrive at our specialty hospitals with multiple infections, a high incidence of resistant organisms and an increased risk for new and recurrent infections. Because patients come to us in fragile condition and often with compromised immune systems, infection control is a major area of focus for Select LTAC hospitals. The Centers for Disease Control and Prevention (CDC) has benchmarked three infection measures for long-term acute care hospitals: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (UTI). Select Medical LTACHs submit infection data through the National Health Safety Network (NHSN) which is the report arm of the CDC. With the exception of one quarter, Select Medical average Ventilator Associated Pneumonia (VAP) rate has been 36 to 71 percent lower than the CDC LTACH mean VAP rate for the past two years.
75 percent of Select Medical Hospitals have 0.0 VAP infections
Across all Select Medical hospitals, catheter-associated urinary tract infections (CAUTI) have been shifting toward lower rates. A similar shift has occurred in the distribution of Central Line Associated Blood Steam infections (CLABSI) rates from Select Medical LTACHs, which has been a major area of focus due to a high degree of morbidity and mortality associated with this type of infection.
There has been much interest in reducing the use of antibiotics for all types of hospitals and care settings and an abundance of evidence to support the case for antibiotic stewardship. Yet according to the CDC such programs are often absent in hospitals today. Overuse of antibiotics can lead to increased resistance by bacteria to these medicines, illnesses that cause diarrhea, and injury to the patient for medications that may not be needed. Tracking the average antibiotic charge per patient day facilitates a determination of the relative use of antibiotics at Select Medical LTACHs. The average antibiotic charge per patient day decreased from 2009 to 2011, for Select Medical LTACHs that began the Antibiotic Stewardship program in 2008.
Other important quality indicators that we continually monitor are hospital-acquired wounds and falls with injury. Patients in Select LTAC hospitals have a very low rate of acquiring pressure wounds and prevention remains a focus of our care. Hospital-acquired pressure ulcer rates have been decreasing since the beginning of 2010, reaching a hospital average of less than one per 1,000 patient days and rates are expected to decline further in 2012 because of the implementation of pressure ulcer reduction protocols at all Select Medical LTACHs. Select Medical also monitors the risk of patient injury due to falls. Falls with injury are tracked as the number of falls of severity level 2 or greater per 1,000 patient days. (A level 2 injury requires first-aid or follow up treatment.)
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