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A BSTRACTS
D102
Clinician’s perception of infections and laboratory utilization at a
long term care facility.
J. Kopacz, 1,5 P. D. Sychangco, 2 D. Russo, 2,5 Z. Huang, 2,5 N. Mariano, 1,3
C. Urban, 1,3 S. Segal-Maurer. 1,4 1. Infectious Diseases Section, NYHQ,
Flushing, NY; 2. Geriatrics Division, NYHQ, Flushing, NY; 3.
Microbiology, NYHQ, Flushing, NY; 4. Medicine, Weill Cornell
Medical College, New York, NY; 5. SCNR, Briarwood, NY.
Introduction
Infectious Diseases (ID) consults are not readily available in
long term care facilities (LTCFs). This study assesses clinician perception
of incidence and prevalence of infections, laboratory utilization
and use of antibiotics at a LTCF.
Materials and Methods
A two-step study was conducted at a 320-bed, hospital-affiliated
LTCF: 1. Six month retrospective analysis of all microbiologic specimens
; 2. 14 question IRB approved survey assessing number of patients
treated, use of diagnostic tests, perceived frequency of infections,
and choice of antibiotics. Answer choices included “never,
rarely, sometimes, often, always.” Clinicians did not have access to retrospective
laboratory data collection.
Results
All 11 LTCF healthcare (HCWs) providers (9 MDs, 2 RNP)
completed the survey. Blood tests were ordered with a change in
physical exam by 8 HCWs “often” and 3 “always” (chest radiographs
infrequently). All HCWs stated urine infections were most common
and they “always” ordered urinalysis (UA) to accompany urine cultures
(UCx). Of 435 UCx specimens, 264 (61%) were positive. Of
these, 236 (89.4%) had an accompanying UA (85% positive). Six
HCWs ordered blood cultures (BCx) “often” and all stated “sometimes”
or “rarely” found the results helpful. Of 167 patients who had
BCxs, 13 (7.7%) were positive with 3 (1.8%) considered true bacteremia
(6 of 13 patients received unnecessary treatment). Perceived
C difficile infection (CDI) prevalence was over 25% and all HCWs
“often” ordered CDI assays. Of 889 CDI assays sent, 94 (11%) were
positive (by ELISA). In spite of CDI concern, fluoroquinolones were
the most frequently prescribed antibiotics. All HCWs stated they
would use an antibiogram if available.
Conclusions
Positive UAs correlated well with positive UCx, obviating use of
routine UAs for all patients. BCx were rarely positive and not clinically
useful, consistent with clinicians’ impression (cost savings
$1,895). CDI rates may be underestimated with ELISA assay and education
is required to limit use of CDI associated antibiotics. HCW
education via an antibiotic stewardship program would improve laboratory
utilization and antibiotic use, help reduce nosocomial infections,
and lead to cost savings.
D103
Nursing home improvement collaborative to reduce potentially
avoidable hospital transfers.
R. Tena-Nelson, 4 K. Santos, 4 L. Herndon, 5 E. Weingast, 2 S. Amrhein, 4
K. S. Boockvar, 2,1 J. Ouslander. 3 1. JJP VA Medical Center, Bronx,
NY; 2. Jewish Home Lifecare, New York, NY; 3. Florida Atlantic
University, Boca Raton, FL; 4. Continuing Care Leadership
Coalition, New York, NY; 5. Massachusetts Senior Care Foundation,
Boston, MA.
Supported By: New York State Departments of Health and Labor
Background: Nursing home (NH) residents experience frequent
hospital transfers, some avoidable. Interventions to Reduce Acute
Care Transfers (INTERACT) provides tools and strategies to assist
NH staff in early identification, communication, and documentation
of changes in resident status.
Objective: To implement INTERACT among members of Continuing
Care Leadership Coalition (CCLC), a NY metropolitan area
NH provider association, and evaluate educational and hospitalization
impacts.
Methods: Funding was obtained from a NY State health workforce
training grant. Members of CCLC were invited to participate
regardless of their baseline transfer rate. 13 education sessions (7 inperson)
were conducted over 1 year. Sessions engaged NH executives,
department heads, front-line nursing staff and their labor union,
and staff from NHs’ partner hospitals. Topics included the INTER-
ACT implementation process; use of simple standardized communication
tools, advance care planning tools, care paths, and change in
condition support tools; quality review of hospital transfers; exercises
for refining clinical skills; teamwork; and lessons learned. One session
used a high-fidelity patient case simulator.
Results: There were 150 participants from 32 facilities. 94% of
NHs were non-profit with 331 beds on average. After training 84%
of participants responded that they were more confident in educating
others about interventions to reduce preventable hospitalizations.
Eighty percent indicated that their organization had a plan in
place to coordinate INTERACT efforts in the next 3 months with a
referring hospital. NHs reported high acceptance of, and compliance
with, use of INTERACT tools. To date, two NHs reported 37% and
18% reductions in hospital transfers as compared to the year prior to
implementation.
Conclusions: Use of a collaborative model among a group of
urban nursing homes resulted in good acceptance and uptake of the
INTERACT intervention. The program has the potential to impact
NH resident care through standardized approaches to communication,
early identification of clinical issues, decision-support, and support
for stronger partnerships between acute and post-acute care
providers.
D104
The PEACE Pilot Study: Convergence of Geriatrics and
Palliative Care.
K. R. Allen, 1,2 S. M. Radwany, 2,3 D. J. Kropp, 3,2 D. Ertle, 4
S. Fosnight, 2,3 P. Moore, 2 S. E. Hazelett. 2 1. Geriatrics & LifeLong
Health, Riverside Health System, Newport News, VA; 2. Summa
Health System, Akron, OH; 3. DFCM, NEOMED, Rootstown, OH; 4.
Area Agency on Aging 10B, Uniontown, OH.
Supported By: National Palliative Care Research Center
(NPCRC)and
The Summa Foundation
Background: Although geriatrics and palliative care are distinct
disciplines, the populations they serve often overlap, especially for
home-bound patients with chronic life-threatening illness.
Purpose: To describe the feasibility of a randomized pilot study
testing the effectiveness of a geriatrics/palliative care (PC) hybrid intervention
to deliver early in-home interdisciplinary care management
to improve the quality of PC in Ohio’s community-based longterm
care Medicaid waiver program, PASSPORT.
Methods: New PASSPORT enrollees were randomized to the
intervention (n=40) or usual care (n=40). The intervention involves
an in-home geriatrics/PC needs assessment by a trained PASSPORT
case manager (CM). The CM presents the findings to an interdisciplinary
team who devise an individualized care plan based on the consumer’s
goals and best practice guidelines. The CM implements the
plan with the consumer, family and primary care physician (PCP).
The primary outcomes upon which we expected our intervention to
have a positive effect include: 1) Symptom management, 2) Quality of
life, 3) Mood, 4) Decision making/care planning, and 5) Spirituality.
Results: No significant differences were found between groups
regarding baseline demographics. At 6 months no differences were
found in performance of ADLs or IADLs. Mean differences and 95%
confidence intervals were calculated for each of the primary outcomes.
All confidence intervals included zero indicating no significant
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AGS 2012 ANNUAL MEETING