Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions.

OBJECTIVE: To determine the appropriateness of transfers to acute care hospitals from a nursing home.
DESIGN: Nursing home and hospital records of all the nursing home residents during the 3-year study period were reviewed retrospectively to determine: number and type of transfers; problems identified in the nursing home justifying the transfers; diagnoses made at the hospitals; length of hospital stays; outcome of hospital visits.
SETTING: An 80-bed public nursing home.
SUBJECTS: 112 residents in the nursing home over the 3-year study period. MAIN OUTCOME MEASURES: Based on the decision of the hospital physician, those transfers resulting in hospital admissions were considered appropriate. As well, transfers to the emergency room with return to the nursing home without hospital admission were also judged to be appropriate if the problems required diagnostic and therapeutic procedures not available in the nursing home.
RESULTS: During the 3-year study period, 55 residents (49%) were transferred a total of 102 times. An average of 26% of patients were transferred each year. Direct admissions to acute hospitals accounted for 17% of the transfers, transfers to the emergency room with subsequent admission for 34%, and transfers to the emergency room with subsequent return to the nursing home without admission for 45%. Four percent of patients transferred died in the emergency room. On the basis of the outcome measure, 7% of all transfers could have been diagnosed and treated in the nursing home and were considered inappropriate.
CONCLUSIONS: The majority of transfers from this nursing home to acute-care hospitals were appropriate.