Clinical impact of pressure ulcers in patients admitted to a rehabilitation unit of an

Intermediate Care Hospital

Santaeugenia S, Álvaro M, García M, Monterde A, Gutiérrez A, Alventosa AM, Mas MA

Department of Geriatric Medicine and Palliative Care Badalona Serveis Assistencials

Catalonia, Spain, EU

There is evidence of the usefulness of inpatient rehabilitation units specially designed to manage complex problems of older patients after acute illness Pressure ulcers (PU) are frequent in these patients, due to functional loss associated with acute illness in vulnerable patients The aim of this study was to assess the effect of pressure ulcers during the rehabilitation process

Introduction

Bachmann S et al. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 2010;340:c1718

A pilot study was performed during the period from January 2010 to December 2011 in several geriatric rehabilitation units of our Intermediate Care hospital

Method (I)

Main clinical outcomes were analyzed based on the presence of pressure ulcers at admission •  Functional gain •  Length of Stay •  Acute rehospitalisation •  Discharge Long Term Care Unit

Description of the intervention: •  Provided by a multidisciplinary care team

(Medical, Nursing, Physiotherapy, Occupational Therapy, Social Worker)

•  Treatment of post acute conditions

•  Comprehensive Geriatric Assessment (multidimensional assessment followed by an individualized care plan)

•  Rehabilitation

Method (II)

N 668 patients

Results (I): characteristics at admission

Age 82 (9) Gender female 68% Referred from: acute care 87% / Community 13%

Charlson Co morbidity Index 2 (2)

Main diagnostic group: - Orthopedic 46% - Medical 30% - Stroke 18% - Surgical 6% Presence of pressure ulcers at admission 16%

Variables are % except Age and Charlson CI: mean (SD)

Variables are % except Barthel Index Granger version at admission: mean (standard deviation)

Results (II): characteristics based on PU at admission

PU No PU p value

Barthel Index at admission* 33 (25) 44 (25) <0.05

Malnutrition at admission* 23% 16% <0.05

Cognitive Impairment 27% 23.5% 0.249

Results (III): PU at admission based on diagnostic group

% PU at admission

Surgical* 37

Medical 16

Orthopedic 15

Stroke 11

P<0.05

Variables are mean (standard deviation), except mortality %

Results (IV): outcomes based on PU at admission

PU No PU p value

Length of Stay* 70 (42) days 59 (37) days < 0.05

Barthel Index at discharge* 53 (34) 69 (33) < 0.05

Mortality 8% 5% 0.1

Variables are %

Results (V): destination based on PU at admission

Pressure ulcers

No pressure

ulcers Acute Care 8% 6%

Long Term Care 14% 6%

Home* 69% 82%

p< 0.05

Pressure ulcers are frequent at admission in our rehabilitation units, specially in surgical patients Several factors at admission, as functional status or malnutrition seemed related with PU presence

Conclusions (I)

Pressure ulcers have a negative impact both in the clinical evolution and outcomes of patients of our rehabilitation units •  Worst functional outcome at discharge

•  Higher Length of Stay in the rehabilitation unit

•  Lower destination home (due to higher destination Long Term Care)

Conclusions (II)

In our experience it would be necessary to improve the prevention of pressure ulcers in acute units, specially in surgical departments More research is needed to find strategies for good management of pressure ulcers, allowing better inpatient clinical evolution in rehabilitation units

Conclusions (III)

Thank you

Contact Dr. Miquel A. Mas (Badalona Serveis Assistencials)

mmas7@bsa.cat