急救三环理论在抗震救灾医疗救护中的应用

2003年10月中华医学会急诊医疗分会第五届委员会第二次全体会议提出并确定了创伤急救"三环理论"的概念,即院前急救、急诊科的救治和创伤重症监测与救治.几年来,它对指导创伤急救工作起到了积极的作用.     

急救一体化模式在严重多发伤的救治中的优越性

目的探讨在急诊科开展严重多发伤急救一体化模式的优越性。方法2000年后本院在新的急诊医学模式下,集外科各类创伤的急诊抢救,急诊手术、危重症监护治疗及康复于一体,对严重多发伤进行整体化治疗。结果9年内本院急救中心外科共收治607例严重多发伤,一体化治疗后死亡31例,存活率为94．9％。结论急救一体化模式明显提高了多发伤尤其是严重多发伤的救治成功率。     

佛山市南海区“四台合一”创伤救治模式的现况研究

目的分析＂四台合一＂的新型模式下创伤救治效果。方法随机抽取佛山市南海区二级甲等以上医院4个,收集由＂110＂通知而急诊出车接收的2008年8月至2009年8月符合要求的创伤患者,分析急诊出车急救半径分布、平均应急反应时间分布情况。结果急诊出车急救半径≤10km最多,占60.35%,平均应急反应时间大多在l0min以内。结论 ＂四台合一＂的新型模式,适合我国国情的城市创伤急救网络模式,提高突发事件急救的组织能力和伤员救治的成功率,值得推广。     

几种常见创伤急救处理原则 创伤急救处理的新进展

创伤均为突发的意外事故 ,大多伤者原先为健康者。因此 ,创伤成功的救治 ,无论对伤者个人、家庭和社会均有重要意义。现就近年来我国在创伤急救处理方面的某些新进展 ,简述如下。1　城市急诊医疗服务体系有了较好的发展我国城市急诊医疗服务体系 (ｅｍｅｒｇｅｎｃｙｍｅｄｉ ｃａｌｓｅｒｖｉｃｅｓｓｙｓｔｅｍ ,ＥＭＳＳ) ,即院前急救→医院急诊科→急诊ＩＣＵ ,这些方面的建设 ,有了较好的发展 ,此乃争取伤后“黄金 1小时”救治的重要保证。我国大多城市均已建立了急救医疗中心 (站 ) ,某些城市近年来设置了先进的通讯手段 ,其中包括装…     

上海市创伤急救病人院内诊治模式调查

目的 :了解上海市医疗机构创伤急救病人院内诊治模式现状,推动创伤急救体系与国际接轨。方法 :通过实地走访调查、焦点讨论、专家论证等多种方法,了解14所医疗机构中创伤院内急救的行政建制、院内创伤急救医师队伍的设置和培训水平等情况,比较创伤急救病人院内诊治模式对多发伤救治死亡率的影响。结果 :目前上海各医疗机构的急救病人院内创伤诊治模式主要有两种,第一种模式为创伤中心制,有5所;第二种模式为急诊科首诊负责制和/或急救中心全科医师制,有9所。第一种模式在创伤专用急救设施、急诊检查与手术室配置相对比较完善,且在创伤患者分级评分、创伤专业团队规范化业务培训优于第二种模式;两种模式创伤急救医师的学历构成、职称结构、专业结构配置和专科背景无显著差异;两种模式在建立院内创伤数据库方面都不够完善,难以为创伤急救质量的评价提供客观标准。结论 :目前上海市多数医院仍然采取急诊科首诊负责制或急救中心全科医师制,创伤中心制的医疗机构在创伤患者的急救方面具有管理模式上的优势,建议有条件的医院尽早成立创伤中心,加强创伤急救人才队伍的规范培训、从全市层面建立创伤数据库迫在眉睫。     

急诊死亡205例病因分析

目的具体分析我院急诊死亡患者的病因情况,提高急诊科危重患者的抢救成功率。方法回顾分析我院行院前急救、急诊科抢救无效死亡患者(205例)的临床资料。结果儿童急诊患者以意外性事故为主体;青少年患者的急诊类型为急性中毒、意外事故、创伤、猝死;中老年患者主要表现为心脑血管疾病。其中女性患者以中毒表现的最为明显,而男性患者则以创伤、心血管疾病患者为主。患者急诊死亡的主要原因依次为外伤、心血管系统疾病、脑血管系统疾病,院前死亡原因表现为猝死、心血管疾病、呼吸疾病。结论做好急救知识宣传,提高公民自身的急救意识,建立更为完善的急救网络系统以及紧急创伤救治平台,提高急诊抢救的成功率。     

基层医院急诊建设及管理的探讨

本文探讨基层医院急诊建设、急诊管理及急救人才培养策略。从不同方面阐述了基层医院急诊科目前存在的诸多问题：如没有固定编制,开展工作以“完全依赖型”为主,劳动强度大、待遇低、纠纷多、易受暴力威胁,职称晋升困难,人员流动性大等。针对这些问题,提出了切实可行的解决办法：基层医院建立“支援型”急诊科,以现代急诊医学新的“三环理论”指导急诊日常工作,积极开展院前急救,加强院内急救力量,建立急诊重症监护病房,千方百计拓展和延伸急诊服务,方便患者;建立健全规章制度,严格落实,确保安全;加强人才培养,提高职业素质,建设全科医学模式急诊科,提高抢救成功率,增加社会效益。为基层医院急诊建设及管理提供经验。     

多发性创伤急诊救治体会

目的:探讨进一步提高多发性创伤在急诊科的急诊救治。方法:通过对本院急诊科多发性创伤患者的救治体会进行综合分析。结果:抢救室抢救成功349例(97%),死亡12例(3.3%)。结论:多发性创伤病情复杂,病程进展快,诊治难度大,并发症多,死亡率高。急诊科应及时采取措施,做出快速、正确、有效的急诊救治。对提高多发性创伤抢救成功率有重要意义。     

急诊“120”对2034例急诊患者抢救分析

目的 探讨急诊“120”对医院急诊室救治水平的影响。方法 分析2034例急诊“120”病例的临床情况及院内救治转归。结果 急诊疾病谱前5位分别是急性损伤、昏迷、急性中毒、心脑疾病、消化系统疾病.2034例筛出多种特殊情况得出本组病例的抢救成功率为98．83％；“无名氏”群体18例（0．88％），这部分病例给急诊临床和社会带来了新问题，如何将其损失；庙少到最小范围，这仍有待今后继续探讨。急诊“120”的病例进入急诊后给专科（占56％）和各专科ICU（占44％）输送病源。急诊“120”在应付突发、灾难性事件方面显示了很强的应急能力。结论 急诊“120”是我院急诊科的主要病例来源，是“院前急救—急诊室救治—ICU及专科病房救治三位一体的急救模式的重要组成部分。     

严重多发伤的急救措施

目的探讨急诊科建立的对严重多发伤的救治措施。方法从早期急救措施,中期急救措施,后期急救措施的综合实施,急诊科建立了对严重多发伤的救治措施。结果救治严重多发伤82例。其中43例在急诊科开展急诊手术和重症监护治疗,死亡7例,39例在急救中心初步救治后转入专科病房,死亡7例。结论在急诊科建立一套对严重多发伤完善的能指导工作的救治措施可以提高抢救的成功率。     

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.001) and a decrease of 9.5 h in emergency department length of stay per average visit per patient (p<0.001). There was no significant effect on the number of hospitalizations or hospital length of stay. This intervention demonstrated a correlation with reducing emergency department use in patients with behavioral health issues, but no correlation with reducing hospital utilization. This under-researched approach of integrating medical records at point-of-care could serve as a model for better emergency department management of behavioral health patients.     

严重创伤院前院内强化一体化救治体系的效果研究

目的探讨院前院内强化一体化急救模式在严重创伤患者救治过程中的应用价值。 方法实验组(强化一体化救治组)以镇江市第一人民医院急诊医学中心2017年1月至2017年12月接收的128例患者为研究对象进行回顾性研究,其中男性78例,女性50 例;年龄31～59 岁,平均年龄(39.34±4.0)岁。急救医师通过无线数据连接实时将现场救治场景和患者各项信息传送到拟转送的目标医院,到达医院后急救医师与急诊医师共同完成创伤救治的ABCDE流程后离院;对照组(传统急救模式组)为镇江市急救中心在2016年12月至2016年12月期间送往镇江市第一人民医院急诊医学中心135例严重创伤患者。比较两组患者一般资料、急诊室停留时间、ICU监护时间、病死率以及住院时间,对救治效果进行评估。 结果实验组与对照组相比较,在急诊室停留时间[(35.34±18.19)min] VS [(50.45±15.39)min]、ICU监护时间[(6.8±5.6)d]VS[(9.2±3.4)d]、病死率(7.81%) VS (12.59%)以及住院时间[(29.8±3.4)d] VS [(35.7±4.5)d]均优于对照组,差异有统计学意义(P<0.05)。 结论院前、院内强化一体化急救模式能够有效缩短严重创伤患者抢救时间,更快地在"黄金1 h"内稳定生命体征,最终提高严重创伤患者的救治成功率,具有临床推广价值。     

急诊科全科医师培训的实践与探索

全科医师培训是大型综合性教学医院临床教学和医疗工作的重要组成部分,培训学习是全科医师提高专业技术水平的重要途径。急诊科是全科医师培训的重要基地,全科医师的培训对急诊科乃至急诊医学的发展都非常重要。本文旨在加强全科医师的筛选,保证生源质量;注意因材施教,突出实践能力培养;拓展培养空间,注重综合能力提高;建立考评机制,调动教学双方积极性;使用与关爱结合,提供良好的后续发展支持等方面,对于提高综合性教学医院急诊科全科医师培训质量进行了有益的探索。使急诊科全科医师临床实际操作技能、专业理论知识、临床诊疗思维和职业道德素质均有了新的提高,为其今后的终生教育和发展成为一名合格的急诊科医师奠定良好基础。本文总结了急诊科全科医师培训过程中的优势和不足,并对此提出了相应的建议。     

“Hidden” Value: How Indirect Benefits of Health Information Exchange Further Promote Sustainability

Background

Health information exchanges (HIEs) have already demonstrated direct value in controlling the costs associated with utilization of emergency department services and with inpatient admissions from the emergency department. HIEs may also affect inpatient admissions originating from outside of the emergency department.

Objective

To assess if a potential association exists between a community-based HIE being used in hospital emergency departments and inpatient admissions emanating from outside of the emergency department.

Methods

The study design was observational, with an eligible population of fully insured plan members who sought emergency department care on at least 2 occasions over the study period between December 2008 and March 2010. Utilization data, obtained from medical and pharmacy claims, were matched to a list of emergency department utilizers where HIE querying could have occurred. Of the eligible members, 1482 underwent propensity score matching to create two 325-member groups—(1) a test group in which the HIE database was queried for all members in all of their emergency department visits, and (2) a control group in which the HIE database was not queried for any of the members in any emergency department visit.

Results

A post–propensity matching analysis showed that although the test group had more admissions per 1000 members overall (199 more admissions per 1000 members) than the control group, these admissions might have been more appropriate for inpatient treatment in general. The relative risk of an admission by the time of a first emergency department visit was 28% higher in the control group than the test group, although by the time of a second emergency department visit, it was only 8% lower in the control group. Moreover, test group admissions resulted in less time spent as inpatients, which was denoted by bed days per 1000 members (771 fewer bed days per 1000 members) and by average length of stay (4.27 days per admission for all admissions and 0.95 days per admission when catastrophic cases were removed).

Conclusions

Based on these results, HIE availability in the care of patients presenting to the emergency department is associated with fewer inpatient hospital days and a shorter length of stay, even when catastrophic cases are removed from the analysis. Although many factors can play a role in this finding, it is possible that HIE promotion of more appropriate hospital admissions from outside of the emergency department is one cause. Such “indirect” value shows that the return on investment found by HIEs may even be greater than previously calculated. Additional study is warranted to further the business case for HIE investment for the various stakeholders who are interested in supporting HIE sustainability.The eighteenth-century essayist and satirist Jonathan Swift made the observation that “vision is the art of seeing things invisible.” So, too, is “the art of seeing things invisible” a key for the ongoing sustainability of health information exchange (HIE). HIEs have long been theorized to provide a number of tangible benefits. These benefits accrue through the provision of medical history at the point of care: decreases in redundant laboratory testing, improved provider efficiency, improved care coordination, increased quality of care, and the ultimate goal of an overall decreased cost of care.

KEY POINTS

• ▸ Health information exchanges (HIEs) have shown direct value in controlling costs related to emergency department utilization and inpatient admissions from the emergency department.
• ▸ The costs associated with inpatient admissions, which account for the majority of healthcare dollars spent, are on the rise; 44% of all hospital admissions originate in the emergency department.
• ▸ Two previous studies have shown average savings ranging from $26 to $29 for HIE use in the emergency department; a third study showed a decrease in hospital admissions from the emergency department as well.
• ▸ The current study shows that making HIE available for patients in the emergency department reduces the length of hospital stays for admissions not tied to emergency department services.
• ▸ The noted decreased length of stay, even when catastrophic cases are removed from the analysis, suggests that the availability of HIEs in the emergency department reduces inpatient utilization emanating from outside of the emergency department.
• ▸ These findings further support that incorporating the use of HIEs in the emergency department can reduce overall hospital admissions rates, lower the length of hospital stay, and, therefore, decrease the associated costs.

More recently, we have witnessed a seismic movement from theory to practice with definitive dollar savings noted for HIE use in emergency departments in Indianapolis, IN,1 and in Milwaukee, WI2 ($26 and $29 savings per emergency department visit, respectively),1,2 as well as in Memphis, TN (approximately net $1.1 million in savings for the community at large).3 Moreover, in Memphis, the great majority of dollar savings (97.6%) resulted from the avoidance of inpatient admissions from the emergency department.3 Inpatient admissions account for the preponderance of dollars spent in healthcare. Costs for inpatient admissions in the United States are increasing; during calendar year 2004, the average inpatient admission cost was $10,0304; by 2008, this increased to $15,017.5A community replicating the Memphis experience by mitigating inpatient admissions from the emergency department should experience financial savings as Memphis did. The Memphis experience showed that HIE availability within the emergency department decreases direct admissions from the emergency department.3 But can HIE availability in the emergency department indirectly impact admissions emanating from outside of the emergency department? Is the risk of any inpatient admission occurring altered by the presence of HIE in the emergency department? If so, the community benefits indirectly, as well as directly, from having said HIE occurs within the emergency department. However, achieving that benefit requires HIE sustainability, and HIE sustainability requires a stable source of funding. Enhancing the business case for HIE sustainability by uncovering such indirect or “hidden” value may help validate the need for external support and funding.     

Emergency department chart auditing in a family practice residency program

A prospective audit of process on 1,200 consecutive patients seen in the emergency department by family practice residents was performed at the Family Practice Residency Program in Gainesville, Florida. The overall quality of care delivered conformed to the standards of "good medical care" as judged by the author in 85.6 percent of cases. Resident errors were detected in the remaining 14.4 percent of cases, and occurred most frequently among physicians in the earlier years of training (P less than .005). Ultimate patient management was changed by the audit in only 1 percent of cases but potentially had an important impact on the care of these patients. Errors of inadequate documentation were common among residents irrespective of their level of training. An ongoing audit of emergency department charts with regular feedback on medical process and recording appears to be useful both as an educational tool and as a method of improving emergency care.     

Risk of unplanned emergency department readmission after an acute-care hospital discharge among geriatric inpatients: Results from the geriatric EDEN cohort study

Objectives

The study aims 1) to examine whether items of the brief geriatric assessment (BGA) or their combinations predicted the risk of unplanned emergency department readmission after an acute care hospital discharge among geriatric inpatients, and 2) to determine whether BGA could be used as a prognostic tool for unplanned emergency department readmission.

Methods

A total of 312 older patients (mean age, 84.6 ± 5.4 years; 64.1% female) hospitalized in acute care wards after an emergency department visit were recruited in this observational prospective cohort study and separated into 2 groups based on the occurrence or not of an unplanned emergency department readmission during a 12-month follow-up period after their hospital discharge. A 6-item BGA was performed at emergency department admission before the discharge to acute care wards. Information on incident unplanned emergency department readmission was prospectively collected by phone call and by consulting the hospital registry. Several combinations of items of BGA identifying three levels of risk of unplanned emergency department readmission (i.e., low risk, intermediate risk and high risk) were examined.

Results

The unplanned emergency department readmission was more frequently associated with a temporal disorientation (P=0.004). Area under receiver operating characteristic curves of unplanned emergency department readmission based on BGA items and their combinations ranged from 0.53 to 0.61. The best predictor of unplanned emergency department readmission was the temporal disorientation (hazard ratio>1.65, P<0.035), which defined the high-risk group. Inpatients classified in high-risk group of unplanned emergency department readmission were more frequently readmitted to emergency department than those in intermediate- and low-risk groups (P log Rank <0.004). Prognostic values for unplanned emergency department readmission of items and their combinations were poor with sensitivity below 67%, specificity ranging from 36.4 to 53.7, and positive likelihood ratio below 1.4.

Conclusions

The items of BGA and their combinations were significant risk factors for unplanned emergency department readmission, but their prognostic value was poor.

     

The role of race/ethnicity in the relationship between emergency department use and intimate partner violence: findings from the 2002 National Survey on Drug Use and Health

Objectives. We examined the relationship between intimate partner violence victimization among women in the general population and emergency department use. We sought to discern whether race/ethnicity moderates this relationship and to explore these relationships in race/ethnic–specific models.Methods. We used data on non-Hispanic White, Non-Hispanic Black, and His-panic married or cohabiting women from the 2002 National Survey on Drug Use and Health. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using logistic regression.Results. Women who reported intimate partner violence victimization were 1.5 times more likely than were nonvictims to use the emergency department, after we accounted for race/ethnicity and substance use. In race/ethnic–specific analyses, only Hispanic victims were more likely than their nonvictim counterparts to use the emergency department (AOR = 3.68; 95% CI = 1.89, 7.18), whereas substance use factors varied among groups.Conclusions. Our findings suggest that the emergency department is an opportune setting to screen for intimate partner violence victimization, especially among Hispanic women. Future research should focus on why Hispanic victims are more likely to use the emergency department compared with nonvictims, with regard to socioeconomic and cultural determinants of health care utilization.Intimate partner violence (IPV) against women has been associated with increased healthcare utilization overall1^–5 and with non–primary care services in particular.6^–8 For example, nearly 40% of the approximately 4.8 million rape and violent physical incidents perpetrated by intimate partners each year result in injury and about 30% of injured women receive medical care.7 The majority of these women receive treatment in a hospital setting, with more than half treated in an emergency department. Multiple medical care visits are frequently required for each incident, resulting in nearly 500 000 emergency department visits each year by women victims, as well as costs to consumers, employers, and the public health system of more than $168.5 million per year for emergency department visits alone.7Although racial and ethnic disparities in the relationship between IPV and emergency department utilization have not been reported in studies of nonclinical samples, several related paths of research point in this direction. First, the extant literature overall suggests that IPV occurs more frequently among Blacks and, to a lesser extent, Hispan-ics compared with Whites in general population surveys.9 Second, alcohol use is associated with IPV, especially among Black women. The 1995 National Study of Couples,10 for example, found that women exposed to male-perpetrated IPV were more likely than were nonexposed women to report alcohol problems and drug use, particularly women of Black or “other” race/ethnicity who experienced severe IPV. Likewise, Cae-tano et al.11 found social consequences of drinking, but not dependence symptoms, among female partners to be associated with male-to-female IPV only among Black couples. However, White and Chen12 found a woman’s problem drinking to be associated with her victimization in a study among a predominately White population. All of these analyses controlled for partner drinking. It remains unclear whether substance use precedes or follows IPV, but the current literature suggests that women may “self-medicate” to alleviate the effects of partner violence.13^–16Third, race/ethnicity is a factor in the utilization of emergency department services and in alcohol-related emergency department use. Black and Hispanic women are more likely to utilize emergency department and in-patient hospital services compared with non-Hispanic White women,17^–24 and alcohol-related visits to the emergency department for Blacks are approximately twice that of Whites overall.25 Further, women’s (and their partners’) use of illicit drugs and alcohol abuse are associated with IPV among ethnic minorities who attend urban emergency departments, with IPV-related injury among women victims in emergency department studies, and with severe IPV in female trauma patients.26^–30 Taken together, these findings suggest that Black and Hispanic women are more likely than are White women to utilize the emergency department, that Black and Hispanic women who have experienced IPV are more likely than their non-victim counterparts to utilize the emergency department, and that substance abuse may play a role in these relationships.Many of the studies that have addressed the relationship between IPV and emergency department utilization have been clinic- or hospital-based studies. These studies may introduce detection bias by differentially including those individuals who lack access to primary care or those who have the ability to pay (or have insurance) for emergency department services, depending on the socioeconomic status of the population served.19^,21^,31^–36 Few population-based self-report surveys have examined health care utilization,37^–39 aside from those focused on IPV incident–specific care, such as the National Violence Against Women Survey conducted 10 years ago.To address these gaps in the literature, we aimed to (1) examine the relationship between IPV victimization among women and emergency department utilization in the general population, while accounting for race/ ethnicity and substance use; (2) discern whether race/ethnicity is a moderator in the relationship between IPV and emergency department use; and (3) examine the relationship between IPV and emergency department use in race/ethnic–specific analyses in the event race/ethnicity was found to be a moderating factor.     

Confidential enquiry into avoidable vehicle accident deaths in the province of Modena,Italy

The authors describe the methods and results of a kind of study – confidential enquiries into avoidable deaths – very rarely performed in the Mediterranean area. After assessing some quali/quantitative evaluation criteria, an independent expert panel investigated the quality of each step in emergency health care. Information was collected by clinical and forensic reports (clinical method). Of 102 cases, 4 were avoidable deaths and 18 probably avoidable. These results, which are comparable with other similar ones found in Italy (autoptic method) and abroad, have been useful in highlighting some health care errors: in particular, in on-site care and in emergency department diagnosis and treatment. Other avoidable factors emerging were the inappropriateness of transporting severe trauma cases to a small hospital lacking proper equipment and trained staff, and the importance of staff training in first emergency care of severe trauma on ambulance. This situation had been highlighted previously and led to implementation of trauma centres. The methods implemented turned out to be quite statistically reproducible and have been used in local health care planning, especially in the rearrangement of ambulance deployment and emergency staff training.     

Nonemergency medicine-trained physician coverage in rural emergency departments.

CONTEXT: Rural areas have fewer physicians compared to urban areas, and rural emergency departments often rely on community or contracted providers for staffing. The emergency department workforce is composed of a variety of physician specialties and clinicians. PURPOSE: To determine the distribution of emergency department clinicians and the proportion of care they provide across the rural-urban continuum. METHODS: Cross-sectional analysis of secondary data. The distribution of clinicians who provide emergency department care by county was determined using the 2003 Area Resource File. The percentage of emergency department care provided by clinician type was determined using 2003 Medicare claims data. Logistic regression analyses assessed the odds of being seen by different clinicians with a patient's rurality when presenting to the emergency department. FINDINGS: Board-certified emergency physicians provide 75% of all emergency department care, but only 48% for Medicare beneficiaries of the most rural of counties. The bulk of the remainder of emergency department care is largely provided by family physicians and general internists, with the percentage increasing with rurality. The likelihood of being seen by an emergency physician in the emergency department decreases 5-fold as rurality increases, while being seen by a family physician increases 7-fold. CONCLUSION: Nonemergency physicians provide a significant portion of emergency department care, particularly in rural areas. Medical specialties must cooperate to ensure the availability of high-quality emergency department care to all Americans regardless of physician specialty.     

Intermediate hospital care for subacute elderly patients as an alternative to prolonged acute hospitalization

Objective

We evaluated the rapid discharge of older patients with reactivated chronic diseases from an acute general hospital to an intermediate care hospital.

Methods

A cohort study was carried out. Compliance with predefined quality standards and patient selection were evaluated.

Results

Sixty-eight patients (mean age 82.6 years, 48.5% men) were discharged from the emergency department (69.1%) or medical wards (mean [SD] global length of stay 2.6 [2.9] days in acute wards and 1.5 [1.6] days in the emergency department). Mean post-acute length of stay (SD) was 11.4 (4.2) days. Fifty-six patients (82.4%) were discharged to their previous living situation (home or nursing home), two back to the emergency department, seven to long-term care, and three died. All quality standards were met. In a multivariate analysis, male gender and a higher risk of malnutrition were associated with an increased risk of not returning to the previous living situation (p <0.05).

Conclusions

Intermediate care for selected patients with reactivated chronic diseases might represent an alternative to prolonged acute hospitalization.