The integrated care pathway for individuals with severe disability resulting from brain injury: a descriptive retrospective study from the project for the Accreditation Canada Distinction program.
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Abstract
INTRODUCTION
A severe Acquired Brain Injury (sABI) is formally defined as an acquired brain injury that results in a comatose state, characterized by an acute-phase Glasgow Coma Scale (GCS) score of ≤ 8 persisting for more than 24 hours. Despite advances in complex case management, patients with severe Acquired Brain Injury (sABI) and extremely severe disability, often experience inappropriate hospitalization. This persistence in acute care or rehabilitation wards significantly contributes to the phenomenon of delayed discharge. The project launched by the ULSS 3 - Venezia health authority, initiated for participation in the “Accreditation Canada - Stroke Distinction” and “Accreditation Canada - Trauma Distinction” programs, aims to facilitate the community reintegration phase for these individuals.
MATERIALS AND METHODS
This study utilized a retrospective descriptive design to assess the characteristics of a cohort of individuals with sABI referred to the ULSS 3 facility. The analysis specifically focused on management indicators (e.g., hospital length of stay and delayed discharge metrics), clinical status, and multidimensional features. Eligibility for inclusion in the extra-hospital reintegration project was established through consensus during a dedicated multidisciplinary committee meeting.
RESULTS
A cohort of seven individuals (four males, three females) was included in this analysis. The cohort presented with a mean age of 64.14 ± 17.7 (37-86) years and a mean acute-phase GCS score of 6.4 ± 1.91 in the initial 24 hours. Upon review by the joint committee, all patients exhibited a high level of assistance required for Activities of Daily Living (ADL), mobility, and nursing care. The rehabilitation enrollment of these subjects occurred, on average, after 23.4 days. The mean length of stay (LOS) was 180.5 ± 65.1 (91-282) days. Furthermore, the mean duration between the formal approval for discharge and the actual patient discharge was 39.4 ± 32.2 (7-84) days.
DISCUSSION
The included patient population demonstrated a very high level of functional complexity and nursing care dependency. The institutional project is based on the "intermediate care" model, in which service delivery is organized to ensure integration and continuity of patient care. This project may assist not only in managing the phenomenon of "delayed discharge" but also in the social reintegration of the patient.
CONCLUSIONS
Patients with sABI, characterized by severe disability and high dependency on care, may remain in acute care units. Projects aimed at facilitating the extra-hospital reintegration phase may mitigate the phenomenon of delayed discharge and inappropriate hospitalization. However, prospective studies with adequate statistical power are necessary to confirm this hypothesis.
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Riferimenti bibliografici
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