NTI 2016 Interview - The Important Role of LTACHs in the Healthcare System
I was extremely fortunate to have the opportunity to interview Christi Sifri RN, MN who is the Chief Nurse Executive of Regional Hospital in Washington. With the decreased length of stay mandated by regulatory bodies the long term acute care hospital (LTAC), fills the gap between acute care hospital and long term care centers and home.
Long-term acute care hospitals (LTAC) often get confused with long-term care and skilled nursing facilities. However, they are acute hospitals with nurses skilled at taking care of highly complex, chronically critically ill patients. The deconditioned ICU patient that is having difficulty weaning off of the vent and requires dialysis or has a complex wound is a patient that will oftentimes go to the LTAC for vent weaning and continued care. LTACs are important in the care continuum, as they provide much-needed ICU bed relief. Currently, the definition from CMS (Medicare) of a patient that qualifies for LTAC is a patient with a 3-day ICU length of stay or 96 hrs on the vent. On the other end, to qualify as an LTAC the average length of stay must be greater than or equal to 25 days.
This showcases several issues surrounding LTAC patients: what is the definition of chronically critically ill? Does a three day ICU stay automatically label a patient as chronically critically ill? Also, what other patient population is defined by a length of stay instead of the medical issues surrounding the patient and the services that they require?
The average length of stay (LOS) is 35-36 days. There is no maximum LOS, but patients must be recertified and requalified for this level of care. Case managers and social workers work in interdisciplinary teams to attain the highest level of care.
When asked what skills she looks for when hiring nurses for the LTAC, Christi answered that she looks for ICU experience or very strong med-surg time. Nurses must be able to transition from one level of care to next. For instance as the patient progresses from an ICU environment to a med-surg level of care to a more stable long term environment.
As May 2016 graduates are entering the workforce, I asked if new grads be considered? Christi said yes, LTACs do consider new grads. They have had senior nursing students who have been mentored at their facility and then were hired upon graduation. She related this has been a positive experience for both the students and their facility.
Central lines are an inherent risk for sepsis and with CMS guidelines now in place in the form of the Hospital-Acquired Condition Reduction Program, I asked Christi how her staff works together to reduce central line associated sepsis cases? "Just by the nature of the LTACH, we vigorously work as a team to reduce central line related bloodstream infections. We have a dedicated nurse/team that utilize a bundled approach. This bundled approach is based in recent research that proves that a bundled, standardized approach to central line care markedly reduces hospital-acquired infections.
Core measures of this study include:
- Central catheter dressings intact and occlusive
- Date present on dressing
- Dressings initialed
- Dressing changed in less than 7 days
- Daily assessment of dressing site
- Chlorhexidine dressing in place
The central line associated infections fell 29% after initiation of this bundled approach to care. Decreasing line infections significantly reduces morbidity and mortality as well as length of stay."
Finally, I asked Christi what she would like to tell our readers and she wanted to clarify that LTACs are often confused with long term care and that it is important for patients, families and nurses to know the differences.
Hospital Acquired Condition Reduction Program - CMS guidelines to reduce hospital acquired infections
Use of Central Catheter Maintenance Bundle in Long Term Acute Hospitals
About tnbutterfly, BSN, RN Admin
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allnurses Community Manager; from US
Specialty: 30+ year(s) of experience in Peds, Med-Surg, Disaster Nsg, Parish NsgMay 17, '16Thanks for clarifying the difference between LTAC and SNFs. Hopefully employers recognize the skill level of nurses who work in LTACs.Aug 28, '17Thank you for this article. As an LTACH nurse, it's hard to describe exactly what I do. When people hear long term they assume SNF. When people hear vents and trachs they assume ICU. What I do is unique. I may have one patient who is with us due to a complex wound, another who is recently decannulated, and still another trying to fight the vent. These are in addition to a long term patient who is a failure to wean plus one who has recently been withdrawn from life support. I care for them all equally, along with their family members that visit (or don't). It's unlike anything I ever expected after graduating from, but I wouldn't trade it for anything.
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