The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Making the Transaction from Acute to Subacute Care: What Works? What Doesn't Work?

Berit Darby, RN, NHA Sunday, November 3, 1996

Defines and describes the difference between skilled and subacute care. Describes admission and discharge criteria for pulmonary care program. Explains the role of the RCP in the interdisciplinary team and in the subacute unit. Highlights physical plant issues.

Subacute Care - SNF Regulations

* Physician orders

* Evaluation

* Assessment

* Care planning

* Documentation


* Discharge summary

Subacute Care - Dr. Orders

* RT Evaluation

* Treatment orders

* Modalities

* Medication with dosage and frequency

* Duration of treatment

* Diagnosis for which patients is receiving medications by RT

Subacute Care- Evaluation

* Dr. order prior to initiation of skilled RT services

* Establish problems, goals, and approaches


From Acute to Subacute Care

Berit Kuntz-Darby, RN, BSN, NHA

Vice President of Subacute Services

Regency Health Services, Inc.

Transitioning from Acute to Subacute Care Continuum of Care

* Acute

* Subacute

* Skilled nursing facility

* Home/Lower level of care

Subacute Care - Regulations

* Medicare

* Title 18

* OBRA '87

* Medicaid/MediCal

* Title 19/Title 22

* Joint Commission


Subacute Care - Assessment

* Screen within 24 hours of admission

* Evaluation within 48 hours of admission

* Evaluate for lesser interventions such as decreased frequency or intensity of modalities

* Assess daily need for continuing same order

Subacute Care - Care Planning

* Multidisciplinary

* Interdisciplinary

* Update every 2 weeks

Subacute Care - Documentation

* Evaluation documentation

* Onset date

* Prior respiratory status

* Short and long term measurable goals

* Ability to perform ADL's

* Daily RT notes

* Weekly summary

Subacute Care - CQI

* Documentation of services

* Appropriateness of therapy

* Equipment safety

* Infection control

Subacute Care - D/C Summary

* Part of the last treatment visit

* Identification of progress of patient

* Accomplishment of goals established in initial evaluation

Subacute Care - OBRA 87

* Residents Rights

* Quality of Life

* Resident behavior and Facility practices

* Resident Assessment

* Quality of Care

Subacute Care - Clinical Skills

* Basic Skills

* Infection Control

* Medical Gas Therapy

* Aerosol Therapy

* Lung Expansion Therapy

* Chest Physiotherapy

* Emergency Procedures

* Airway Management

* Diagnostic Procedures

* Ventilator Care

* Pulmonary Rehabilitation

Subacute Care - SNF regulations impacting RCP

* Contract with hospital

* Hospital Transfer agreement

* RCP on staff at that hospital

* On-staff RT in the Subacute Unit

* RT reimbursed based on time on premises

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