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Soru

Zorluk: OrtaDisposition and Care Setting Transitions

An 84-year-old man is evaluated on postoperative day 4 following a right hip hemiarthroplasty for a femoral neck fracture. His postoperative course has been uncomplicated, and his pain is well-controlled with oral acetaminophen. His past medical history includes hypertension, diet-controlled type 2 diabetes mellitus, and mild osteoarthritis. Vital signs are within normal limits. The surgical incision is clean and intact. Before the fall, the patient lived in a single-story home with his 82-year-old wife, who uses a wheeled walker for mobility. Prior to hospitalization, he ambulated independently. He currently requires maximum assistance for transfers and can only take a few steps with a walker. Physical and occupational therapy evaluate him and note that while he is highly motivated, he fatigues rapidly, participating in only 45 minutes of therapy per session before requiring a prolonged rest. The therapy team recommends continued daily rehabilitation. Which of the following is the most appropriate disposition for this patient?

  1. Discharge to a skilled nursing facilityCevap
  2. B
    Discharge to an inpatient rehabilitation facility
  3. C
    Discharge home with home health services
  4. D
    Transfer to a long-term acute care hospital
  5. E
    Remain in the acute care hospital for continued physical therapy

Cevap

Discharge to a skilled nursing facility
The correct disposition is a skilled nursing facility. The patient is medically stable and ready for discharge from acute care, but requires continued daily therapy and assistance with mobility. Because his elderly wife relies on a walker, she cannot safely provide the maximum assistance he currently needs for transfers, making a discharge home unsafe. Although he needs daily rehabilitation, his inability to tolerate more than 45 minutes of therapy per session precludes admission to an inpatient rehabilitation facility, which requires patients to tolerate at least 3 hours of therapy per day. A skilled nursing facility provides the appropriate level of skilled nursing, daily subacute rehabilitation (typically 1-2 hours daily), and assistance with activities of daily living.

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1
Assess the patient's medical stability and continued care needs.
The patient is medically stable, his pain is controlled, and his surgical site is healing. He requires continued daily physical and occupational therapy to regain functional independence.
Determining medical stability differentiates the need for acute care from post-acute care.
2
Evaluate the safety and feasibility of a home discharge.
The patient requires maximum assistance for transfers. His wife uses a walker and cannot safely provide this assistance, making a direct discharge home unsafe.
Social support and functional status dictate whether a patient can safely return to the community.
3
Determine the appropriate institutional post-acute care setting based on the patient's therapy tolerance.
The patient fatigues after 45 minutes of therapy. This disqualifies him from an inpatient rehabilitation facility, which requires tolerance of 3 hours of therapy daily. A skilled nursing facility is the correct choice as it matches his rehabilitation endurance.
Medicare guidelines strictly regulate admission criteria for post-acute care facilities based on therapy requirements and patient endurance.

Anahtar Kavram

Disposition to an inpatient rehabilitation facility (IRF) requires the patient to tolerate 3 hours of intensive therapy daily; patients needing rehabilitation who cannot meet this requirement should be referred to a skilled nursing facility (SNF).
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Konular

Disposition and Care Setting Transitions

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