S. Brooks et al., THE PHYSICIAN DECISION-MAKING PROCESS IN TRANSFERRING NURSING-HOME PATIENTS TO THE HOSPITAL, Archives of internal medicine, 154(8), 1994, pp. 902-908
Background: Each year more than 25% of nursing home patients are trans
ferred to the emergency department or hospital for evaluation and trea
tment of infection. These transfers may have an adverse impact on the
quality and cost of patient care. This study examined physician assess
ment and management of acute infections in the nursing home. Methods:
A cross-sectional study was conducted of all acute urinary tract infec
tions and lower respiratory tract infections occurring from February t
hrough June 1991 in eight randomly selected urban nursing homes. The n
umbers of transfers to the emergency department or hospital were recor
ded along with identification of the clinical, psychosocial, and insti
tutional factors that influenced the physician's decision to transfer.
Results: Three hundred fifty-nine patients had 258 urinary tract infe
ctions and 219 respiratory tract infections. Eighty-one (17%) of these
events resulted in transfer to a hospital for evaluation (16/81) and/
or admission (65/81). Less than one third (30.4%) of the events caused
the patient to be examined in the nursing home by a physician before
the decision to transfer to the hospital. The mean time between the st
aff notification of an acute event and physician response by telephone
was 5.12 hours. Independent mobility (P less than or equal to.05), a
transfer to the hospital during the previous 6 months (P less than or
equal to.01), and fewer nursing home laboratory tests and treatments (
P less than or equal to.01) were all associated with hospital transfer
. Conclusions: In this sample of acutely ill nursing home patients, ph
ysicians collected limited clinical data before the decision to transf
er. Although some transfers maybe appropriate, a reduction in the tran
sfer rate may reduce health care costs and limit the risk of iatrogene
sis, thus improving the outcome of acute illnesses occurring in the nu
rsing home.