Long-Term Care Survey Alert

Hint: Sometimes the answer to a problem is 'all of the above.'

A high resident re-hospitalization rate  may herald a survey fall, but don't jump to conclusions about its cause if you want to resolve it once and for all.

Case in point: In doing a root-cause analysis of an escalating rate of hospitalizations at one nursing facility, Laura Ferrara, RN, MSN, and her quality assurance team found several issues that needed correcting. They then formulated an action plan to prevent unnecessary hospitalizations, which included the following strategies:

1. Educate referring hospitals about the facility's subacute care capabilities. "The hospital emergency department staff didn't know the facility could provide that level of care. So they'd get a patient from the facility who simply needed an IV line restarted - and then admit the person to the hospital," says Ferrara. To resolve that problem, the nursing facility management gave hospitals a heads up about their high-intensity nursing services, including IV therapy.

2. Provide continuing education for facility nurses to address problems leading to hospitalization or emergency room visits. Examples included fine-tuning IV techniques so nurses can restart difficult lines - or handling patients on ventilators who go into respiratory distress, explains Ferrara.

3. Focus more on palliative care education and goals to identify resident/family goals for hospitalization up front. "The staff strive to make sure the residents/families understand whether they want hospitalization under certain circumstances - and the consequences of hospitalizations beforehand," Ferrara reports. The facility is also talking to a group of physicians specializing in palliative care to explore the potential for them to work with residents to do a better job in deciding on advance directives.

Editor's Note: This story is based on information presented by Laura Ferrara, RN, MSN, at the most recent American Health Care Association annual conference in Miami, and a follow-up interview with Ferrara.