Appropriateness of the decision to transfer nursing facility residents to the hospital.

Appropriateness of the decision to transfer nursing facility residents to the hospital. Research Abstract Details 

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Appropriateness of the decision to transfer nursing facility residents to the hospital. Abstract Text:

OBJECTIVES: To develop and test a standardized instrument, the purpose of which is to assess (1) whether skilled nursing facilities (SNFs) transfer residents to emergency departments (ED) inappropriately, (2) whether residents are admitted to hospitals inappropriately, (3) and factors associated with inappropriate transfers. DESIGN: A structured implicit review (SIR) of medical records. SETTING AND PARTICIPANTS: Using nested random sampling in eight community SNFs, we identified SNF and hospital records of 100 unscheduled transfers to one of 10 hospitals. MEASUREMENTS: Seven trained physician reviewers assessed appropriateness using a SIR form designed for this study (2 independent reviews per record, 200 total reviews). We measured interrater reliability with kappa statistics and used bivariate analysis to identify factors associated with assessment that transfer was inappropriate. RESULTS: In 36% of ED transfers and 40% of hospital admissions, both reviewers agreed that transfer/admit was inappropriate, meaning the resident could have been cared for safely at a lower level of care. Agreement was high for both ED (percent agreement 84%, kappa .678) and hospital (percent agreement 89%, kappa .779). When advance directives were considered, both reviewers rated 44% of ED transfers and 45% of admissions inappropriate. Factors associated with inappropriateness included the perceptions that: (1) poor quality of care contributed to transfer need, (2) needed services would typically be available in outpatient settings, and (3) the chief complaint did not warrant hospitalization. CONCLUSIONS: Inappropriate transfers are a potentially large problem. Some inappropriate transfers may be associated with poor quality of care in SNFs. This study demonstrates that structured implicit review meets criteria for reliable assessment of inappropriate transfer rates. Structured implicit review may be a valuable tool for identifying inappropriate transfers from SNFs to EDs and hospitals.

Appropriateness of the decision to transfer nursing facility residents to the hospital. Publishing Authors By Initials

For similar health care facilities, manpower, and services: health facilities: residential facilities: nursing homes: skilled nursing facilities research abstracts see: health care facilities, manpower, and services: health facilities: residential facilities: nursing homes: skilled nursing facilities research

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Appropriateness of the decision to transfer nursing facility residents to the hospital. Journal Published:

PUBLICATION TYPE: Research Support, U.S. Gov't,

Journal: Journal of the American Geriatrics Society

VOLUME: 48

Page Numbers: 154-63

Journal Abbreviation: J Am Geriatr Soc

ISSN: 0002-8614

DAY: 10

MONTH: Feb

YEAR: 2000

Appropriateness of the decision to transfer nursing facility residents to the hospital. Information

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LANGUAGE: eng

NlmUniqueID: 7503062

Appropriateness of the decision to transfer nursing facility residents to the hospital. Keywords Mesh Terms:

KEYWORDS: Skilled Nursing Facilities

MESH TERMS: statistics & numerical data

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Grant and Affiliation Information for Appropriateness of the decision to transfer nursing facility residents to the hospital.

AFFILIATION: Geriatric Research Education and Clinical Center, VA Greater Los Angeles Health Care System, USA.

Country: UNITED STATES

AGENCY: United States NIA

GRANT: AG10415

ACRONYM: AG

MEDLINETA: J Am Geriatr Soc

REFSOURCE: J Am Geriatr Soc. 2000 Feb;48(2):230-1

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