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For Physicians

Is My Patient Appropriate for Long-Term Care?

Scenario #1
The patient is a 65-year-old female who is admitted with Coronary Artery Disease (CAD), tachycardia, and sick sinus syndrome. She underwent cardiac cath at the ACH that showed severe CAD. A CABG was performed and she had a permanent pacemaker placed while at the acute care facility.  Post surgery she had a complicated course with ARDS, CHF, UTI and Pneumonia with MRSA in her sputum. She was subsequently weaned from the ventilator. She has a trach in place, which will be downsized. Her CHF is stable but she will remain on Lasix.  She is transferred to the LTACH due to CAD and debility. Medications include Cardizem, ASA, Metamucil, Colace, and Lasix.

Should this patient be admitted to the LTACH?  Answer: No.

If the LTACH did not exist, where would this patient transfer within the next 7 days? This patient's complications have primarily been resolved and the patient appears to be more appropriate for some other venue, such as nursing home or home health.

Scenario #2
This patient with morbid obesity, diabetes, CHF, COPD, Obstructive sleep apnea and CAD was admitted to the ACH for abdominal surgery 2 weeks ago.  Bowel obstruction was found and patient had a complicated course due to CHF and COPD.  Post surgery day 4 the patient spiked a temperature of 103 and was complaining of pain at the incision site.  There was evidence of cellulites of the operative wound and cultures grew MRSA.  She was placed on IV antibiotics.

Patient is being transferred to the LTACH on IV antibiotics due to the wound infection.  She is on Lasix for her CHF, which is improving, and inhalers and supplemental O2 for her COPD and CPAP for OSA.  Patient is deconditioned.  On examination the abdominal wound is mildly reddened and cellulites is present.  Patient's temperature is 99.8.  PT & OT will be ordered.

Should this patient be admitted to the LTACH? Answer: Yes.

Patient is undergoing acute medical treatment.  MRSA wound infection, cellulitis, CHF and deconditioning. ACH takes credit for the abdominal surgery.  LTACH takes credit for the infected surgical wound.  

Scenario #3
This is an 80 year old patient with known history of metastatic carcinomas of the breast.  The patient was admitted to the acute care setting with shortness of breath and severe pain. Patient's history of CHF was R/O as cause of SOB. The cancer pain was found to be associated with increasing shortness of breath. Patient had mastectomy three years ago.  Patient has diabetes mellitus and is malnourished.

Patient is admitted to LTACH for continued pain management and maintain control of her diabetes.  Patient is on IV pain medication on admission and IVF for dehydration.

Plan is to further control the pain associated with the breast cancer.  Blood sugars will be monitored to control her diabetes.  CHF will continue to be monitored.  Nutritional consultation is placed for patient's malnutrition status.  PT and OT will be ordered.

Should this patient be admitted to the LTACH? Answer: No.

Did the ACH resolve the complications? SOB was attributed to cancer pain.  SNF or IRF possibility? Pain control and nutritional status.

Our Care Coordinator and Chief Clinical Officer can help you determine if your patient is appropriate for admission to long-term acute care.  Start by completing our online Referral Form