ABSTRACT
Objectives: To describe the characteristics of a cohort of decannulated patients admitted to a Neuro-rehabilitation and Critical Care Center and their condition upon discharge. The secondary objective was to analyze the existence of possible risk factors associated with referral of patients to a high complexity center. Materials and Method: Descriptive, cross-sectional, retrospective study in the Clínica de Neurorehabilitación Santa Catalina, Autonomous City of Buenos Aires, Argentina. Results: 87 patients were decannulated. 29 patients were admitted with IMVA and could be completely weaned. The median of TQT days was 35 days (IQR 22-68). 21% of decannulated patients were still hospitalized at the institution upon the end of the study. 53% were discharged home alive, whereas 23% had to be referred to a high complexity center. Two decannulated patients died while they were hospitalized. Some variables independently associated with referral to a high complexity center were found, the presence of a neurological history before ICU admission (OR [odds ratio] = 4.22, 95% CI [confidence interval] (1.03-10.5), p = 0.02) and ICU admission for respiratory causes (OR = 4.44, 95% CI (1.22-16.1), p = 0.02). Conclusion: Most decannulated patients were discharged home alive. Neurological history and respiratory disease as reasons for ICU admission could be risk factors to be referred to a high complexity center.
Subject(s)
Humans , Tracheostomy , Respiration, Artificial , Risk FactorsABSTRACT
The purpose of this study was to analyze the socioeconomic factors influencing patient discharge destination and the length of their hospital stay. We investigated 83 consecutive stroke patients admitted to our rehabilitation ward between January 1 and December 31, 2008. The mean age was 68.1 years old, the mean length of stay was 86.1 days, and 57% were men. The outcome for this study was the patient discharge destination, defined as home or a nursing home type of facility. To examine the predictors of the discharge destination, we collected data including patient age, sex, total Functional Independence Measure (FIM) scores at discharge, ‘living alone’, ‘over 65 years old’, ‘requiring public assistance’, and ‘having a family member at home who requires nursing care’. In all, 69 patients were able to return home, and 14 patients were discharged to a nursing home type of facility. The home group showed a higher total FIM score (p<0.001). Logistic regression analysis showed that two factors, ‘living alone’ and ‘having a family member at home who requires nursing care’, adversely affected patient discharge to home. Also, the length of stay was longer among those patients who required public assistance (p<0.01). This study suggests that it is harder for patients to be discharged back to their homes who have these factors : ‘having a family member at home who requires nursing care’ and ‘living alone’. Additionally, having the patient characteristic of ‘requiring public assistance’ could prolong the length of hospital stay.
ABSTRACT
Purposes<br> The purposes of this study were to analyze the relationship between the discharge destinations of patients with cerebrovascular diseases (CVD) in our convalescent rehabilitation ward and their levels of activities of daily living (ADL), and also to consider the factors causing those patients difficulties upon discharge. <br>Methods<br> The subjects were 114 CVD patients in our Convalescent Rehabilitation Ward. <br> The investigation was conducted to examine their ADL score, both at hospitalization and at discharge, and to analyze the relationship between changes in their ADL scores and their discharge destinations. <br>Discussion<br> It was suggested that reduction of the ADL score from above 8 points at hospitalization, to less than 4 at discharge, contributed to improvement of the rate of discharge to the patients' own homes, and that four items in the ADL assessment scale, such as ‘transfer’, ‘ability to communicate’, ‘locomotion’ and ‘oral care’, had an effect on their discharge destinations.
ABSTRACT
OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.