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In the United States, several inpatient settings exist within the healthcare system. Inpatient care takes place when an ailing person spends one patient day in a healthcare facility. On this note, across several facilities in the US, the Hospital Consumer Assessment of Healthcare Providers and systems has been used as an important tool by different hospitals in gauging the patients’ experiences during their inpatient durations at the facilities (Niles, 2011). Based on this tool, many hospitals are now conversant with the collection and evaluation of patient experiences.
Setting of Acute inpatient rehabilitation units
The acute inpatient initiative takes care of patients of over eighteen years who need broad psychiatric assessment as well as treatment to bring their psychiatric warning signs into a state of stability. Also, the patients who require demanding and safe situations are offered with the prospect of crisis intercession and individualized together with structured treatments (Niles, 2011). Moreover, in the acute inpatient units, patients with problems arising from loss of functions due to injuries as well as ailments are enabled to become autonomous in carrying out their daily chores.
The constraints that the acute patients face in individual care comes about due to impaired mobility as well as balance and coordination. Restricted vigor and the scope of movement are also ingredients for the inability of the acute rehab patients to carry out their daily activities (Niles, 2011). Also, the acute rehab patients face the problem of constrained ability of individual care due to loss of sensation, visual and perception troubles together with ingestion muddles and communication problems. Moreover, cognitive dysfunctions characterized by failure in learning and memorizing information as well as organizing, focus, and shifting of attention deprives the acute rehab inpatients of the ability to perceive correctly the environment and to perform calculations (Pozgar, 2007).
The acute inpatient services offer wide-ranging remedies for patients through diverse categories of diagnoses. To begin with, the facilities provide diagnosis for amputation as well as arthritis. Secondly, brain surgery, burns, manifold shocks, hip fractures, and cerebrovascular catastrophes are other varieties of analyses for acute inpatients. Further, structural deformities that are experienced at birth are diagnosed at the acute rehabilitation units. Neurological complications such as multiple sclerosis, Parkinson’s disease, and polyneuropathy as well as Guillain-Barre are also examined at the acute inpatient units (Kurtzman, 2010). Additionally, orthopedic conditions and syndromes such as gout and osteoporosis are diagnosed at the acute inpatient units. Spinal cord injuries and conditions arising from heart ailments are examined in the acute inpatient centers.
In the acute inpatient units, the acute therapy unit utilizes an interdisciplinary paradigm in the achievement of successful treatment (Pozgar, 2007). In other words, the rehabilitation team integrates diverse discipline models into a lone discussion. In this regard, the rehabilitation teams together with the patients assess the history as well as come up with the interventions as well as short-term and long-term management goals (Pozgar, 2007). Through, the patient involvement, the patients are provided with opportunities of exploring diverse avenues that ensure the best outcomes from their conditions. Generally, the interdisciplinary approach is patient-centered thus making it preferred over multidisciplinary approach. Nevertheless, the interdisciplinary approach faces the shortcoming of conventional hierarchies and dominant personality types (Wennberg et al., 2009).
Through the individualized treatments, the patients’ functional capabilities are enhanced (Pozgar, 2007). The treatment team encompasses the medical directors, rehabilitation nurses, physical, occupational and language therapists together with social managers. The team plays vital roles in encouraging the inpatients to get out of bed and involve themselves in daily care activities to enhance autonomy (Pozgar, 2007). Further, the physicians, discharge planners as well as medical care managers undertake referral services. Of importance, before acute inpatients are admitted in the rehab units, they undergo pre-admission screening to enable the determination of the patients to have the prospects of benefits from the hospital-based initiatives (Wennberg et al., 2009).
Trends on the acute inpatient rehabilitation units
Over the years, there has been a steady decline in the number of inpatient beds for example in psychiatric therapies in the US. In essence, the policy initiatives of both public and private sectors have been at the forefront in encouraging short-term as well as the crisis-stabilization paradigm of psychotherapy (Kurtzman, 2010). Due to such policies, the country has seen an escalating trend in readmissions, overcrowding of emergency rooms as well as increased number of patients being locked up in the criminal justice structures (Wennberg et al., 2009). The American society faces serious health obstacles in the management of acute inpatient units in the present day. Moreover, most states such as Chicago show a waning trend in the utilization rates of inpatient services.
Today, the admittance of patients suffering from acute problems takes place at the general hospital units if not the private acute inpatient rehabilitation units. Based on such factors, the acute inpatient rehabilitation units are replaced by outpatient services as well as community-based and residential services (Kurtzman, 2010). Also, studies show that there has been an increasing trend in the number of patients being readmitted to hospitals (Wennberg et al., 2009). For instance, according to the New England journal of medicine, twenty-five percent of patients suffering from neurosis were readmitted to hospitals within a month, which is one of the highest levels of neurosis diagnoses in the history of the American society. In reality, the increased readmissions have led to overcapacity in the inpatient facilities as well as increasing amounts of time taken in the emergency rooms.
Worth noting, the government policies, and programs have been shifted immense expenditures on criminal justice and social welfare at the expense of the healthcare systems (Wennberg et al., 2009). As such, the patients are unable to acquire the much-needed treatments effectively. In fact, in the modern society, many citizens view hospital therapies as an oxymoron. In essence, the operations of most inpatient and outpatient facilities are constrained by the economic, regulatory and legal aspects described in the crisis stabilization paradigm. In other words, admission into the acute inpatient facilities entails several necessities (Pozgar, 2007). For example, patients must provide proof of the acuteness of their conditions. Also, larger proportions of admissions are involuntary. Therefore, legal constraints review the admissions of inpatients thereby leading to discharge of patients who fail to acuteness criteria. In several cases, the health professionals have not been able to respond to emergency calls promptly thereby dealing with treatments of inpatients as well as failing to carry out physical examinations on the inpatients.
Impact of the trends
With the diminishing trends in the number of patients accessing the acute inpatient services, several changes have arisen in the way hospitals engage in the provision of inpatient services (Pozgar, 2007). For instance, most hospitals have shifted their operations not only from the context of acute care diagnostic and therapy activities but also to a cultural modification that is centered on quality value delivery. In other words, the clinical activities on the inpatients are indicated by their conditions (Wennberg et al., 2009). Further, inpatient rehabilitation facilities due to overcrowding and high costs have been forced to undertake capacity planning as well as building initiatives aimed at reducing costs and congestions within the facilities. Moreover, with the decline in the utilization of inpatient facilities, healthcare models of operations are being transformed (Pozgar, 2007). Many inpatient hospital facilities are embracing value-based care and fee-for-service systems to remain relevant in the provision of inpatient services.
Analysis of the trends
The trends in the utilization of inpatient services signal the shift to the new healthcare models that are value-based care services (Wennberg et al., 2009). Studies indicate that over seventy percent of the US states registered over a four percent drop in the number of patients utilizing the acute inpatient services between the years 2006 and 2011 (Pozgar, 2007). The drop can be attributed to economic downturns. Additionally, declines of over ten percent among the patients covered by Medicare are attributed to financial incentives of new value-based payment models and standardized care approaches that are imperative in the reduction of care variations (Kurtzman, 2010). Optimized service distributions also explain the decreasing trend in the utilization of inpatient services.
With the embracing of the doctor-centric models, the physicians are offered with the opportunity of leadership roles at the focal point of the patient-centered incorporated care. Under such arrangements, recurrent doctor visits and care team approach as well as prompt interventions when the acute conditions arise (Pozgar, 2007). In this regard, acute inpatient rehabilitation beds have been substituted by a free-for-free service program thereby reducing the number of beds in acute inpatient rehabilitation units.
Kurtzman, E. (2010). A transparency and accountability framework for high-value inpatient nursing care. Nursing Economics, 28(5), 295-307.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett Publishers.
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Pozgar, G. D. (2007). Legal aspects of health care administration. Sudbury, MA: Jones and Bartlett Publishers.
Wennberg, J., Bronner, K., Skinner, J., Fisher, E., & Goodman, D. (2009). Inpatient care intensity and patients’ ratings of their hospital experiences. Health Affairs, 28(1), 103-113.