Risk Management for Long-Term Acute Care Hospitals
There are over four hundred long-term acute care hospitals (LTACH) in the United States that house critically ill patients. Sometimes unresponsive or in comas, patients may live there for months, or even years, sustained by respirators and feeding tubes. Some, such as those recovering from accidents, eventually will leave; other patients will be there for the rest of their lives.
About $26 billion a year is spent on critical care in acute care hospitals in the United States. Some estimate that the number of patients in these facilities has more than tripled in the past decade to 380,000.
The reason for this growth is two-fold:
- The increase in our aging population increases the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may send patients to acute care hospitals.
- Improved medications and medical technologies are keeping people alive longer requiring an increased need for intensive care.
The result is an increase in patients who require nearly constant care; they survive intensive care, but must remain on life-support. They cannot go home and a rehabilitation facility cannot meet their needs.
About half of the patients who enter a long-term acute care hospital do not survive more than a year. The rest of the patients are in custodial care. Only 10-15 percent are able to return to an independent life.
Areas of Risk
Risk-prone events in long-term, acute care facilities include malnutrition and dehydration; injurious falls; adverse drug reactions; pressure ulcers; inadequate, incomplete, or missing documentation; elopement or wandering; and overuse and/or misuse of medications (especially psychotropic medications). Although some events are unavoidable, others are the result of understaffing, poor or improper care, and inaccurate or incomplete transfer of information for newly admitted patients.
Possible Areas of Litigation
To be effective, risk management in long-term, acute care facilities requires identification of areas of risk within the facility and implementation of both preventive and corrective actions. The top areas of litigation in these facilities are pressure ulcers, malnutrition and dehydration, and injurious falls. Other areas of possible litigation are elopement, adverse drug events, burns from unsafe smoking practices, untreated or undiagnosed changes in a medical condition, and improper discharge. Claims of negligence against nursing facilities can also involve assault by staff or another resident (resident-to-resident abuse), violation of patient rights (failure to obtain informed consent), and misuse of physical or chemical restraint.
The Importance of a Risk Management Program
Risk management and quality care cannot be separated. Recognition of this fact is the foundation of a good risk management program for long-term, acute care facilities. Good risk management within a long-term, acute care facility requires the support of the administrator, medical director, the director of nursing, and all staff (nursing and support) if it is to succeed.
Two of the most critical areas are documentation and nutrition. Correct and complete chart documentation is essential to support patient care decisions. The hospital should also have an established nutrition screening system that includes initial evaluation of the nutritional needs of the patient, as well as continued reassessment to assure the patient is receiving adequate nutrition and hydration.
At Highland Risk Services, we are ready to help Long-term Acute Care Hospitals meet the challenges of a changing environment where the goal is to elevate the quality of life for residents. Our insurance services encompass innovative solutions for service providers in LTACH. Please contact Highland Risk Services to discuss program availability at our Chicago office at 847-832-9100 or our Lansing office at 517-676-7100.