title: Specialty care delivery: bringing infectious disease expertise to the residents of a Veterans Affairs long-term care facility.
abstract: OBJECTIVE
  To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-site consultations to LTCF residents to improve the care of residents with possible infections.
  
  
  METHODS
  Clinical demonstration project.
  
  
  METHODS
  A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital.
  
  
  METHODS
  Residents referred to the LID team.
  
  
  METHODS
  The reason for and source of LTCF residents' referral to the LID team and their demographic characteristics, infectious disease diagnoses, interventions, and hospitalizations were determined.
  
  
  RESULTS
  Between July 2009 and December 2010, the LID consultation service provided 291 consultations for 250 LTCF residents. Referrals came from LTCF staff (75%) or the VA hospital's ID consult service (25%). The most common diagnoses were Clostridium difficile infection (14%), asymptomatic bacteriuria (10%), and urinary tract infection (10%). More than half of referred residents were receiving antibiotic therapy when they first saw the LID team; 46% of residents required an intervention. The most common interventions, stopping (32%) or starting (26%) antibiotics, were made in accordance with principles of antibiotic stewardship.
  
  
  CONCLUSIONS
  The LID team represents a novel and effective means to bring subspecialty care to LTCF residents.
authors.affiliation: Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. robinjump@gmail.com
authors.forename: Robin L P
authors.initials: RL
authors.lastname: Jump
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Olds
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Jury
authors.forename: Brett
authors.initials: B
authors.lastname: Sitzlar
authors.forename: Elie
authors.initials: E
authors.lastname: Saade
authors.forename: Brook
authors.initials: B
authors.lastname: Watts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000628:therapy; D008134:Long-Term Care / Q000379:methods*; D009017:Morbidity / Q000639:trends; D014481:United States / Q000453:epidemiology; D014728:Veterans