Timing of emergency interhospital transfers from subacute to acute care and patient outcomes: A prospective cohort study.

Aged Aged, 80 and over Emergency Service, Hospital Female Humans Male Outcome Assessment, Health Care Patient Admission Patient Transfer Prospective Studies Victoria
Cohort study Elderly Geriatrics Nursing Patient transfer Readmission Rehabilitation Risk management Subacute care

Journal

International journal of nursing studies
ISSN: 1873-491X
Titre abrégé: Int J Nurs Stud
Pays: England
ID NLM: 0400675

Informations de publication

Date de publication:
Mar 2019
Historique:
received: 06 05 2018
revised: 06 12 2018
accepted: 06 12 2018
pubmed: 25 1 2019
medline: 27 8 2019
entrez: 25 1 2019
Statut: ppublish

Résumé

Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors. To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after subacute care admission. This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study. Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services' acute care hospitals. All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded. Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect. There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on subacute care admission (median 45 vs 66, p < 0.001). Prior to transfer, fewer early transfers had a limitation of medical treatment order in place during their subacute care admission (25.9% vs 48.7%, p < 0.001). The majority of both early and late transfers resulted in acute care hospital readmission (85.1% vs 77.7%, p = 0.204). For patients admitted to acute care, there was no difference in median acute care length of stay (6.5 vs 8 days, p = 0.367). Early transfer patients had fewer in-hospital deaths than late transfer patients (3.8% vs 16.1%, p = 0.004). The high rates of acute care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of care on transfer decisions warrants further investigation.

Sections du résumé

BACKGROUND BACKGROUND
Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors.
OBJECTIVES OBJECTIVE
To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after subacute care admission.
DESIGN METHODS
This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study.
SETTING METHODS
Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services' acute care hospitals.
PARTICIPANTS METHODS
All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded.
METHODS METHODS
Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect.
RESULTS RESULTS
There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on subacute care admission (median 45 vs 66, p < 0.001). Prior to transfer, fewer early transfers had a limitation of medical treatment order in place during their subacute care admission (25.9% vs 48.7%, p < 0.001). The majority of both early and late transfers resulted in acute care hospital readmission (85.1% vs 77.7%, p = 0.204). For patients admitted to acute care, there was no difference in median acute care length of stay (6.5 vs 8 days, p = 0.367). Early transfer patients had fewer in-hospital deaths than late transfer patients (3.8% vs 16.1%, p = 0.004).
CONCLUSIONS CONCLUSIONS
The high rates of acute care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of care on transfer decisions warrants further investigation.

Identifiants

DOI: 10.1016/j.ijnurstu.2018.12.008 PMID: 30677591
pubmed: 30677591
pii: S0020-7489(18)30266-9
doi: 10.1016/j.ijnurstu.2018.12.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Pagination

77-85

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

Julie Considine (J)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Australia. Electronic address: julie.considine@deakin.edu.au.

Maryann Street (M)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Australia.

Alison M Hutchinson (AM)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Monash Health Partnership, Australia.

Tracey Bucknall (T)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Alfred Health Partnership, Australia.

Helen Rawson (H)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Monash Health Partnership, Australia.

Anastasia F Hutchison (AF)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Australia.

Trisha Dunning (T)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Barwon Health Partnership, Australia.

Maxine M Duke (MM)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Australia.

Mohammadreza Mohebbi (M)

Deakin University, Geelong, Faculty of Health Biostatistics Unit, Australia.

Mari Botti (M)

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Timing of emergency interhospital transfers...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Timing of emergency interhospital transfers...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Timing of emergency interhospital transfers...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Timing of emergency interhospital transfers...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Timing of emergency interhospital transfers...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Admission du patient › Timing of emergency interhospital transfers...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Transfert de patient › Timing of emergency interhospital transfers...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Timing of emergency interhospital transfers...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Victoria › Timing of emergency interhospital transfers...