Post-Acute Care for Chronically Critically Ill

Patients dependent on advanced technology for survival are referred to as “chronically critically ill.” Their care often lacks continuity due to transfers between various services within and between hospitals. Disrupted care transitions may result in less effective management. A new care model was developed to improve continuity of care between the acute care hospital and the long-term acute care hospital [LTACH] by utilizing a multidisciplinary team that operates in both settings. The model has been well-received by patients, families, and staff at both institutions. Patients managed under this model have experienced reduced thirty-day readmission rates at the acute hospital despite stable Elixhauser scores. These findings suggest that an approach emphasizing continuity of care between institutions is an effective strategy for managing chronically critically ill patients.

Keywords:Chronic critical illness; Continuity of care; Long-term acute care