Coping with the complicated management of infectious diseases is among the many challenges facing long-term care facilities today. Residents with multiple comorbidities often are prescribed broad-spectrum antibiotics and it seems as though methicillin-resistant Staphylococcus aureus (MRSA) and other (increasingly) drug-resistant bugs are everywhere. Outbreaks are common, ranging from norovirus and influenza to Clostridium difficile and scabies.
While most long-term care facilities have not historically recruited infectious disease expertise, for the safety and well-being of all residents, as well as for the financial welfare of the facility, that needs to change. It’s likely that long-term care facilities soon will be faced with an outcomes-based reimbursement model similar to that of acute care hospitals, meaning cost-containment will be even more important.
From my experience as an infectious diseases physician whose practice works with more than 25 long-term care facilities in the Chicago area, ID consultation can save a 100-bed facility $65,000-$100,000 a year, not to mention improving quality of life for residents. The cost savings and improved outcomes are driven by three areas that infectious diseases specialists can directly influence:
- Optimize isolation: The first thing we do when we begin work with a long-term care facility is examine their isolation practices. There is a tendency to over-isolate residents by taking a “better safe than sorry” approach as the healthcare workers try to follow often-confusing isolation guidelines.
While there certainly are times residents need to be isolated – such as for an active MRSA infection, or an uncontained draining wound – far more often isolation is not warranted and in fact is detrimental. Frequently, patients who are only colonized with an organism are placed in a restrictive form of isolation (contact) with minimal benefit. Releasing residents from unnecessary isolation not only saves money, but can have a substantial effect on a patient’s quality of life as they are able to socialize and move freely about the facility. More important is the implementation of appropriate isolation, minimizing the risk of transmission to other patients in the facility.
- Implement antibiotic stewardship: Overuse of antibiotics is costly and leads to antibiotic resistance, a major concern for hospitals, long-term care facilities and patients. Like isolation, antibiotics often are prescribed unnecessarily. Every time we can take someone off of an antibiotic we can decrease the likelihood that an organism may become resistant to the antibiotic. In other cases, we can make a difference in care by switching from an intravenous to an oral antibiotic. In an outbreak situation, rapid identification and treatment of infected patients may limit the spread of the disease, and decrease the morbidity to the patients. Appropriately utilizing antibiotics is a critical component of patient care in the long-term care facility and another place where significant cost savings can be realized.
- Decrease hospital admission: Infection is one of the most common reasons for transfer from long-term care to an acute care setting. More aggressive management of residents who may present with symptoms possibly associated with an infection decreases the likelihood of their being transferred to the hospital. An infectious disease physician has the capacity to rapidly identify, diagnose and treat these patients, frequently in the long-term care facility. Currently, acute care hospitals may be penalized financially if patients are readmitted within 30 days of discharge. A similar scenario tying payments to quality measures is likely to unfold in the future for long-term care facilities, making a more comprehensive infection control program mandatory.
Ideally, all long-term care facilities would have access to infectious diseases physicians. In situations where this is not feasible, emerging telemedicine techniques and creative staffing, such as specialized training for nurses and other medical staff at a facility, may provide a solution. As the population ages and their comorbidities and illnesses become more serious, the need for ID consultation will only increase.
Ultimately, the most important benefit of ID consultation is patient satisfaction and an improved quality of life for them and their families.
Russell M. Petrak, M.D. is the managing partner, Metro Infectious Diseases Consultants, in Burr Ridge, IL.