Although we can make every effort to make the resident bedrooms as safe aspossible, we will not eliminate falls and we will not eliminate injuries, butrather create the power to minimize the morbidity and the number of theseevents.Disclosures: All authors have stated that there are no disclosures to be madethat are pertinent to this abstract.

Day of week/hospital readmission rate-is there a correlation?

Presenting Author(s): Roy J. Goldberg, MD, Kings Harbor Multicare Center,Montefiore Medical Center/Albert Einstein College of MedicineAuthor(s): Roy J. Goldberg, MD, CMD; Louis A. Kaplan, PA-C; Lisa J.Boucher, PA-C

Introduction/Objective: Subacute rehabilitation centers strive to providefirst-rate care, minimizing the need for re-hospitalizations to referring hospi-tals. To ensure appropriate medical staffing to minimize “bounce-backs,” weevaluated all patients requiring a hospital readmission over a two-year periodfrom our 107 bed subacute facility. This study compared day of week patternsto number of patients requiring readmission.Design/Methodology: Retrospective chart reviewResults: Expected findings included:

1) Increased readmissions over weekends due to fewer medical personneland supervisory nurses present in facility.

2) Increase readmissions on Mondays when medical staff returns3) Increased readmissions on Fridays in anticipation of a weekend.

These hypotheses were not supported by the statistics. Surprisingly, therewere significantly fewer readmissions on Saturdays and Sundays during everymonth evaluated. There was no difference in readmission rates on anyweekday from Monday through Friday.Conclusion/Discussion: Possible explanations include:

1) Increased hospitalizations during the week due to the medical staffproactively diagnosing and treating problems.

2) The abundance of labs and x-rays ordered weekdays precipitatingreadmissions.

3) Patients seeing subspecialists during the week who recommend surgeryor procedures.

4) Medical interventions/iatrogenic complications leading to increasedhospitalizations.

5) Unstable weekday admissions requiring quick rehospitalization for fur-ther stabilization.

Decreased weekend hospitalizations may be due to:

1) Deferred identification of problems although a lack of a Monday spikemakes this doubtful.

2) Increased in-house expirations during weekends although our in-houseexpiration statistics do not support this.

3) Increased visitors on weekends improving patients’ health-status.4) More attentive nursing staff on weekends due to decreased time de-

mands of meetings and paperwork than during the week.

Although there are many possible explanations, a multifactorial etiology ismost likely. From these results, increased weekend coverage by in-housephysicians/physician assistants was not instituted as a method of decreasingrehospitalization of subacute residents.Disclosures: Louis A. Kaplan, PA-C received a speaker honorarium fromHealthpoint, Ltd. Roy J. Goldberg, MD, CMD and Lisa J. Boucher, PA-Chave no disclosures to be made that are pertinent to this abstract.

MODELS OF CAREA practical approach in monitoring both pain and disruptive behaviors ina long-term care setting

Presenting Author(s): Victor Bartling, DO, CMD, TVC, Denali Care Center/Fairbanks Memorial HospitalAuthor(s): Victor Bartling, DO, CMD; Lisa Sanders, RN

Introduction/Objective: With the introduction of CMS regulations for mon-

itoring pain and disruptive behavior, our long term care facility devised amultidiscipline process 5 years ago.Design/Methodology: Our long term care facility has developed a team ofcare providers that participate in an intervention group called BIT/PIT(behavior intervention team/pain intervention team) whereby residents areidentified, treated, and monitored for both disruptive behaviors and pain.BIT/PIT teams have been created on each resident wing. Daily assessmentsare carried out by nursing staff and once pain and behavioral issues aretriggered they are initially assessed by the wing BIT/PIT team. When app-propriate, pain treatment is started by nursing staff through standing orders.Behavioral issues are addressed by using behavioral modification techniquesdeveloped by the wing BIT/PIT team. Weekly wing BIT/PIT meetings areconducted to review assessment/treatment plans and to forward problematicpatients to the administrative BIT/PIT committee (which also meets weeklyand consists of; medical directors, nurse aides/nurses/social services from eachwing, psychiatry, and pharmacy). At weekly administrative BIT/PIT meetingsresident treatment plans are reviewed to ensure that appropriate psycho-tropic/pain medications are being used. Recommendations for medicationchanges and therapeutic interventions are forwarded to the wing BIT/PITteam. This process continues until the residents needs are met.Results: We will present 3 yrs of collected data from the BIT/PIT process.Conclusion/Discussion: We have found this BIT/PIT process to be a successwhich has empowered care providers who are in daily contact with residentsto begin the active process of recognizing, assessing, and intiating treatment.This approach has open the doors of commmunication between staff andadministration to better ensure that our residents’ needs are appropriatelyaddressed and treated within the guidelines provided through CMS regula-tions.Disclosures: Victor Bartling, DO, CMD has no disclosures to be made thatare pertinent to this abstract.

Physician practice models in nursing homes

Presenting Author(s): Sing-I Tsai, MD, University of Colorado Health SciencesCenterAuthor(s): Sing-I Tsai, MD; Cari R. Levy, MD, CMD; Andrew Kramer, MD

Introduction/Objective: Understanding the role of physician oversight in themedical care of nursing home residents is of critical importance. In this study,the use and impact of various physician practice models in nursing homes aredescribed through interviews of nursing home stakeholders.Design/Methodology: A purposeful sample of eight nursing homes was se-lected for study. A variety of geographic regions, sizes, and physician practicearrangements were represented among the selected nursing homes. Stake-holders from each facility included: 1) a physician, 2) the nursing homeadministrator, 3) the medical director, 4) the director of nursing, 5) a socialworker, and 6) one additional stakeholder for each facility who was identifiedby other respondents. Telephone discussions were conducted with open-ended questions about the training of physicians in nursing homes, practicemodels used by physicians, access to care associated with specific practicemodels, and the quality of care provided.Results: Three themes emerged from the stakeholder discussions regardingphysician practices in nursing homes. First, models of care that permittedphysicians to specialize in the care of nursing home residents were valued overother models. Second, nurse practitioners and physician assistants were felt toenable the delivery of more efficient care. Finally, a need to enhance infor-mation exchange between physicians and nursing home staff and acrosssettings of care was emphasized. References were specifically made aboutelectronic medical records and standardized processes to support transfersacross care settings. Discussions appeared to be shaped by factors associatedwith individual nursing home facilities such as the managed care penetrationrate, rural or urban location, and the pervasiveness of liability concerns in theselected facility.Conclusion/Discussion: This study synthesizes themes that recurred duringdiscussions among nursing home stakeholders. Currently, little research isavailable on the features identified here as being important components ofnursing home physician practice models. Issues for further consideration andpotential areas for research on physician practice models in nursing homes arepresented.

POSTER ABSTRACTS B13