Short-stay, or general acute care hospitals, may be under pressure to get patients in and discharged as speedily as possible. Why? They may need the beds if demand is high. There may be financial incentives for them to move patients out as soon as they can, too.

Today’s patients tend to be sicker than ever. More people can live longer with chronic diseases. Sicker patients mean longer stays.

What is the answer?

A new category of hospital, the long-term acute care hospital, was developed to handle such patients.

• A JAMA study shows that these hospitals were found to have extremely low survival rates at the end of one year from discharge.
• In 2008, the Centers for Medicare and Medicaid put a three-year moratorium on new construction of these hospitals.
• More work is needed to identify cost-effective care which can deliver the best outcomes possible for patients who need longer recovery times in a hospital because they were critically ill, according to a journal summary service, Journal Watch.

What Can You Do?

If the patient’s hospital doctor suggests one of these facilities,  be ready to ask many questions.

1. Bring the patient’s own doctor into the decision-making process. That doctor knows the patient and has a point of view which can be important.

2. Is there any alternative to this kind of hospital? This type has been in existence a short time and, as this study shows, have much lower survival rates one year after discharge? That is an important piece of information. Ask: What is this specific hospital’s record on outcomes? If there is no answer, don’t agree until you can find out about this.

3. Another red flag is that Medicare has put a hold on the building of any new acute care long term facilities. That is a big red flag. Know that. Use that in any conversation if you are feeling pushed to agree to let the patient be moved to such a facility.

Journal Watch

“In the U.S., long-term acute-care hospitals have emerged as a care model for patients who are recovering from critical illnesses. However, we know little about patterns of use for such institutions at the national level.”

…”Comment: This study outlines the dramatic rise in the use of long-term acute-care hospitals in the U.S. Financial incentives, rather than proven efficacy, appear to be driving this rapid growth. Short-stay hospitals also might stand to benefit financially by discharging critically ill patients earlier. The overall 1-year survival rate for such patients, however, remains extremely low, particularly among patients who require prolonged mechanical ventilation. As the authors note, in 2008, the Centers for Medicare and Medicaid Services placed a 3-year moratorium on the construction of new long-term acute-care facilities. In an era of limited resources, more work is required to determine the most cost-effective care model to optimize outcomes for patients recovering from critical illnesses.”

Source: Journal Watch Hospital Medicine July 2, 2010

Citation: JAMA, 2010 Jun 9; 303:2253