Discharging Patients to Long Term Acute Care Facilities

This paper will describe the Long Term Acute Care Hospital (LTACH) which is affiliated with Carson Tahoe Hospital (CTH). Long Term Acute Care hospitals were essentially non-existent in 1979. Now, there are over 450 facilities nationwide that are licensed as LTACS (McDaniel, n.d.). The discharge plan I will be describing is for a 66-yr-old female who was admitted to (CTH) for revision of a chronic enterocutaneous fistula which was draining from her abdomen through a very large open wound. This fistula developed as a complication of a subtotal colectomy for ischemic bowel which was performed in February 2012. When the fistula first developed following the colectomy, she was admitted to LTACH with the goal of draining the fistula. Because this was unsuccessful, she returned to Carson Tahoe Hospital to determine the source of the leak and subsequently repair it. She is on a TPN diet, is NPO and is on contact isolation due to a Strep B infection in her wound. The revision surgery was done on April 29, when it was discovered that there was a 1.5 cm ulcerated and perforated area on the anterior portion of her stomach. This gastric percutaneous fistula was repaired and she will be discharged back to LTACH for ongoing IV antibiotics and wound care.
The patient’s discharge plan was determined before she was even admitted to the hospital for this most recent surgery, since she came directly from LTACH. Those involved in deciding her plan of care upon discharge included the LTACH Liaison, Kathleen Diehl, as well as her physician Dr. Miller, her surgeon, Dr. Knoll, the wound nurses and the floor nurses. The medical team is coordinated by the Case Manager on the Surg-Ortho unit and the LTACH Liaison. According to Kim Cruz, the Admissions Coordinator at LTACH, typically the patient’s nurse or doctor will refer the patient to the LTACH Liaison, who will then interview the patient and review their records to determine if they meet the criteria for admission to LTACH, which is