Advances in technology have helped more patients survive acute illness and trauma, and these patients are increasingly transferred to long-term acute care hospitals (LTACHs).

Long-term acute care is a growing segment of the healthcare continuum, and a special commentary in the July 2016 issue of the American Journal of Critical Care (AJCC) provides an overview of LTACHs.

The AJCC commentary, “Long-Term Acute Care: Where Does It Fit in the Health Care Continuum?” describes the roles and practices of LTACHs and how they work in partnership with intensive care units (ICUs) and providers.

LTACHs specialize in the care of high acuity patients who become chronically critically ill and require medical treatment beyond the normal length of stay in a short-stay acute care hospital and beyond the scope of practice of inpatient rehabilitation or skilled nursing facilities. Many of these patients require prolonged mechanical ventilation or have experienced multisystem organ failure. Their recovery may occur slowly over weeks or months.

“LTACHs provide high-quality care to the chronically critically ill patient population and partner with ICUs to ensure these patients transition seamlessly to the best level of care possible, helping to ensure successful clinical outcomes,” said lead author Taryn Miller, RN, DNP, NEA-BC, clinical leadership development specialist with the LTACH division of Select Medical, Mechanicsburg, Pennsylvania. “The LTACH environment, with a focus on the patient’s return to normalcy through the implementation of evidence-based protocols, has produced positive patient outcomes.”

These hospitals may be located within the walls of a short-term acute care hospital, or they can be a freestanding facility. Categorized as a post-acute care facility, an LTACH provides care for patients with higher acuity needs than an inpatient rehabilitation facility or skilled nursing facility.

Patients are frequently referred directly out of the ICU but may also transfer from a progressive care unit or complex medical-surgical setting. Physicians and case managers identify patients who will benefit from an LTACH stay before transitioning them to a lower level of care.

Patients requiring acute dialysis, liberation from mechanical ventilation, complex wound management, management of one or more infectious disease processes, and those who require frequent administration or adjustment of intravenous medications may all be eligible for admission to an LTACH.

LTACHs typically use a multidisciplinary approach to care, which includes physicians, nurses, respiratory therapists, physical therapists, pharmacists, dieticians and case managers, a model which supports improved outcomes.

American Association of Critical-Care Nurses (AACN)