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New long-term acute care facility fills health care void

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When doctors admit their patients to a long-term acute care (LTAC) hospital, it is with good reason and multiple benefits.

They know the effect this level of hospital care has on hastening patient recovery from life's most serious illnesses and injuries. They know that high acuity conditions -- such as ventilator dependency, complex wounds, multi-system failures and resistant infectious diseases -- cannot be as effectively resolved in short-term acute care (STAC) hospital stays, which average four days.

Limited discharge options

Prior to the development of LTAC hospitals, physician discharge options were limited, and when those options proved insufficient, they resulted in a patient's unplanned return into the STAC hospital. Physicians could discharge to home with an extensive rigorous rehab program of office and outpatient clinic visits that can compromise the health of the most frail patients, plus place considerable stress on family members who were not prepared to effectively monitor and provide care for high acuity conditions. In addition, many Home Health Agencies were also unable to care for the type of patients that LTAC hospitals consider routine. Patients could also be discharged to sub-acute, skilled nursing or outpatient rehab facilities that are not equipped to treat multi-system failure or provide intensive wound care.

As an LTAC facility, the 100-bed Promise Hospital of San Diego provides acute medical management and treatment specifically designed for patients who require a longer acute care, hospital-based recovery period for unresolved illnesses, and multi-system disease processes due to severe illness or injury. Utilizing an interdisciplinary approach to treatment, Promise provides aggressive therapy integrated with acute medical care to achieve optimum outcomes for patients requiring critical medical care for ventilator dependency and weaning, cardiomyopathy and congestive heart failure, complications resulting from surgery, infectious disease, comprehensive and complex or aggressive wound care management, etc.

The new 100-bed Promise Hospital of San Diego provides acute medical management and treatment specifically designed for patients who require a longer acute care recovery.

Promise Hospital has on-site CT scanner services; operating room services; full-service laboratory and imaging services; hemodialysis; ICU services; diabetes management; nutritional support; wound care by a certified wound care specialist; oversight of medications by an on-site pharmacist; social services support for patient and family by licensed social workers; 24-hour care by respiratory therapists; physical, occupational and speech therapy; and a team of physicians who make rounds every day to optimize the care of patients. Promise Hospital is JCAHO accredited, Medicare certified, licensed as an acute care hospital and an approved provider for most health insurance plans.

LTAC-level care

Not every patient qualifies for this level of care; there is strict LTAC hospital admission criteria established by government agencies. A patient's medical condition must require an extended hospital stay, averaging 25 days or longer. The services in an LTAC hospital must also include intensive specialized care with aggressive clinical and therapeutic treatment led by a physician and supported by an interdisciplinary team of health care professionals with registered nurses on-site, on a 24-hour/7-day-a-week basis. Most LTAC patients are discharged from a STAC hospital intensive care unit, possibly remaining on life-support, experiencing post-op complications or requiring aggressive care for complex wounds, or intravenous antibiotic administration.

A critical difference

LTAC hospitals are an essential part of the continuum of care, providing a high level of patient care that often transfers patients to a lower level of care like a sub-acute facility or skilled nursing facility (SNF). Many physicians follow their LTAC patients to SNFs and sub-acute facilities to provide the continuity of care for the patient and family.

It is common for consumers, and even physicians, to confuse LTAC hospital treatment with custodian care provided by a SNF (nursing home). This is because specialized LTAC hospital care is relatively new and educational outreach thus far has been limited. Also, there are fewer LTAC hospitals than general acute hospitals or privately held assisted living facilities, which actively market to the public. In addition, the recent surge in awareness, education and aggressive marketing campaigns initiated by insurance companies to sell "long-term" health care insurance policies that cover SNF care has further solidified the association between "long-term" with "nursing home."

The Promise Hospital LTAC model of service:

¥ Affords high-acuity patients with multi-system conditions "the benefit of extended time" that they require in an intensive, interdisciplinary medical facility to effectively hasten recovery and achieve personalized goals;

¥ Enables a referring physician to continue to care for their patient at Promise to provide continuity of care.

¥ Requires that a patient's physician visit them daily for on-site assessment and that intensive nursing intervention is provided on a 24/7 basis. At an SNF, a physician may see a patient once a week or once a month at the facility, or require them to be transported from the facility for office visits.

¥ Provides all interdisciplinary health care services and therapies on-site, eliminating the need for critically ill patients to leave for various ancillary services such as rehabilitative therapies (physical, speech, occupational), wound care treatment, X-rays, dialysis, etc., as would be required for SNF patients. At an LTAC, all disciplines working together on-site with a consistent team approach to recovery enhances staff response time and the communications between physician, health care professionals, patients and their families.

¥ Recognizes that patients and their families are important members of the treatment team, and that building good relationships enhances the healing process. Promise Hospital provides ongoing communication and education to patients and their families throughout the hospital stay.

LTAC: Health care model of the future

The future for LTAC hospitals is now. And as the baby boomer population ages, with a rise in multi-system complications, there will be a growing demand for LTAC level of care.

Promise recognizes the burgeoning need for LTAC specialization in San Diego and is at the forefront in serving the ever-evolving health care needs of those who live and work in San Diego and Imperial counties. At the recent grand opening of Promise Hospital in City Heights, management announced plans to construct a new freestanding LTAC hospital to be built alongside its current facility.


Kaye is with Kaye Communications Inc.

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