Patient Transfer Forms Enhance Key Information Between Nursing Homes and Emergency Department

doi:10.1016/j.gerinurse.2011.05.001

Geriatric Nursing

Volume 32, Issue 4, July–August 2011, Pages 270-275

https://doi.org/10.1016/j.gerinurse.2011.05.001 Get rights and content

The purpose of this study was to determine whether the use of a transfer form increases the availability of essential information needed for patient care and to examine its effect on case resolution time and disposition status. A retrospective review was performed that included patients 65 years old or greater arriving from nursing homes to an academic Emergency Department from January to June 2009. Eighty randomly selected charts were reviewed. Sixteen items were deemed essential based on an expert-based rubric published in 2006. Each case was scored accordingly. Results indicate that the transfer form group had available, on average, 71% of the essential items as compared to 28% for cases without a transfer form (p < 0.001). There was no difference in the case resolution time (p = 0.94) or in disposition status (p = 0.12). In conclusion, essential information for providing emergency department patient care was significantly increased with the use of a transfer form.

Section snippets

Methods

A retrospective study was performed on data from patient electronic medical records. All data were recorded in a study data set as anonymous, that is, without any variables that would permit linkage to medical record or identification. This study was approved by the Saint Louis University Institutional Review Board.

The study population included patients aged ≥65 years transferred by Emergency Medical Services (EMS) from NHs to Saint Louis University ED between January and June 2009. Our

Results

Eighty charts were selected from the 306 NH-to-ED transfers that were identified for data abstraction. There were no significant differences among race, gender, or visit day of week between the 2 groups. There was a statistically significant difference in age (P < .03) with the transfer form group having a mean age of approximately 4 years older (Table 2). The results indicate that there was an increased likelihood of transfer forms being completed in the afternoon hours and less likely in the

Discussion

The study results suggest that information deemed valuable in caring for a patient in the ED has an increased chance of transmission when transfer forms are used. However, the availability of this information did not translate into observable differences in case resolution time and disposition.

The lack of communication between NH and ED staff has been identified in many prior studies.1, 3, 5, 6, 7, 10 Many interventional studies have implemented standardized transfer forms and studied the

Conclusion

Transfer forms enhance communication between nursing home and emergency departments. Essential information for providing ED patient care is significantly increased with the use of a transfer form. However, further studies are necessary to elucidate how to achieve better transfer form adherence to minimize gaps or omissions in patient care upon transfer to the ED. Other areas of research include whether a transfer form checklist may be a more viable option in these transitions of care.

Acknowledgment

Dr. Paniagua is a recipient of a Geriatrics Academic Career Award grant award from the Department of Health and Human Services, Health Resources and Services Administration (Grant No. 1 K01 HP 00118-01).

PREETI DALAWARI, MD, MSPH, is an Assistant Professor in the Department of Surgery, Division of Emergency Medicine and Research Director, St. Louis University School of Medicine, St. Louis, MO.

References (13)

K.M. Terrell et al.
Challenges in transitional care between nursing homes and emergency departments
J Am Med Dir Assoc
(2006)
S.M. Gillespie et al.
Health care providers’ opinions on communication between nursing homes and emergency departments
J Am Med Dir Assoc
(2010)
U. Hwang et al.
The geriatric emergency department
J Am Geriatr Soc
(2007)
J.S. Jones et al.
Patient transfer from nursing home to emergency department: outcomes and policy implications
Acad Emerg Med
(1997)
D.D. Tresch et al.
Relationship of long-term and acute-care facilities. The problem of patient transfer and continuity of care
J Am Geriatr Soc
(1985)
H. Bergman et al.
Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions
J Am Geriatr Soc
(1991)

There are more references available in the full text version of this article.

Cited by (16)

The Impact of Incomplete Nursing Home Transfer Documentation on Emergency Department Care
2019, Journal of the American Medical Directors Association
Emergency department (ED) clinicians rely on the accuracy of written communication when assessing needs of nursing home (NH) residents. This study aimed to review the completeness of NH transfer documentation according to expected core components, as guided by the INTERACT 4.0 quality improvement tool. We also describe the association between patient or facility characteristics and transfer documentation completeness, as well as establish whether information gaps in NH-ED transfer documentation were associated with hospital admission.
Retrospective study using 2 abstractors blinded to the study aims.
474 records from NH residents transferred to the 3 EDs of Rhode Island's largest health care system from September 2015 to September 2016.
NH-ED transfer documentation completeness was reviewed according to the expected core items of transfer documentation, guided by the INTERACT 4.0 quality improvement tool. We used multivariable linear regression with random effects to assess factors associated with NH-ED transfer documentation completion and logistic regression with random effects to assess the relation between information gaps and hospital admission.
Of the 474 NH-ED transfer visits, mean patient age was 76 years; 43% were male, 14% were nonwhite, and 34% had dementia. NH-ED transfer documents were present for 97% of visits, and an average 11.9 of 15 INTERACT core items were complete. Usual mental status and reason for transfer were absent for 75% of patients, whereas functional status was absent for 80%. The multivariable model showed that a higher Charlson Comorbidity Index score (coefficient 0.08, standard error 0.04, P = .03) was associated with more complete documentation. More complete documentation was associated with greater likelihood of hospital admission (adjusted odds ratio = 1.09, 95% confidence interval = 1.01–1.18).
Usual mental and functional status and the reason for transfer are often missing in NH-ED transfer documents and should be incorporated into standardized transfer forms.
“What's the next step?” Improving interfacility emergency department transfer handoff communication
2017, American Journal of Emergency Medicine
Communication between residential aged care facilities and the emergency department: A review of the literature
2014, International Journal of Nursing Studies
Citation Excerpt :
Emergency department staff are reliant on information regarding a patient's clinical, functional and social circumstances being communicated to them to provide appropriate person-centred care and avoid medical errors (Salinas and Ramakrishnan, 2012). However, international studies have identified a gap in communication between aged care facilities and emergency departments with either limited information, or a deficiency of relevant information being provided (Cwinn et al., 2009; Dalawari et al., 2011; Kessler et al., 2013; Lamantia et al., 2010; Platts-Mills et al., 2012; Terrell et al., 2005). Emergency department staff require important clinical and personal information including the medical history, the reason for transfer to the emergency department, presenting symptoms and any advance directives or patient wishes regarding therapy (Salinas and Ramakrishnan, 2012).
Western countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common.
The purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department.
A literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: ‘nursing home’, ‘long-term care’, ‘skilled nursing facility’, ‘aged care facility’, ‘communication’, ‘documentation’, ‘emergency department’, ‘emergency room’, ‘hospital’, ‘acute’, ‘transfer’, and ‘transition’. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained.
There is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes ‘essential transfer information’, clinical practices will continue to vary and resident care will be affected.
This paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.
Shortfalls in residents' transfer documentation: Challenges for emergency department staff
2014, Australasian Emergency Nursing Journal
Increasing numbers of residents are transferred from aged care facilities to emergency departments. Frequently, residents arrive with inadequate documentation regarding their presenting complaint or medical history, making it difficult for emergency department staff to make decisions about care.
A retrospective review of emergency department records was undertaken for residents transferred from residential aged care facilities to two emergency departments in Melbourne, Victoria in 2012.
2880 resident transfers were included in the sample, of which 408 transfers were randomly selected for documentation review. Clinically important documentation was frequently absent including: the reason for transfer to the ED (n = 197, 48.2%); baseline cognitive function (n = 244, 59.7%); and vital signs at time of complaint (n = 285, 69.9%). When the reason for transfer was absent, residents with an altered conscious state had more investigations and spent longer in the emergency department than when the reason for transfer was recorded.
Inadequate documentation negatively impacted the resident's journey through the emergency department. There is evidence that inadequate documentation contributes to poor patient outcomes. To minimise the gaps in the transfer documentation regular staff development and quality assurance programs may be required in residential aged care facilities.
Communication gaps in nursing home transfers to the ED: Impact on turnaround time, disposition, and diagnostic testing
2013, American Journal of Emergency Medicine
Citation Excerpt :
Discerning the individual impact of these items on TAT and amount of diagnostic testing was beyond the scope of our study. Regardless of the finding by us and others, which suggests that better transfer information does not alter ED TAT or disposition, this should not discourage attempts at implementation at better communication, such as standardized transfer forms or Internet-assisted transfers [9,11]. There are other important outcomes, such as reduction of medical error, reduction in spending, mortality outcomes, and patient and physician satisfaction outcomes that have not been the subject of investigation as yet but warrant investigation.
This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing.
A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered.
One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0).
Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing.
Transitions of Care for the Geriatric Patient in the Emergency Department
2013, Clinics in Geriatric Medicine
Citation Excerpt :
The transfers usually occur in urgent or emergent circumstances that do not permit adequate time spent on coordinating the transition. Another major factor identified as contributing to poor coordination of NH-ED transfers is the different financial and reimbursement structures in the NH and the ED, and subsequent lack of incentive for either provider to strive for superior communication.47 To address these shortcomings, various studies have looked at ways to improve NH-ED communication.

View all citing articles on Scopus

PREETI DALAWARI, MD, MSPH, is an Assistant Professor in the Department of Surgery, Division of Emergency Medicine and Research Director, St. Louis University School of Medicine, St. Louis, MO.

JENNIFER DUGGAN, PA-C, MS, St. Louis University Hospital Emergency Department, St. Louis, MO.

VANDANA VANGIMALLA, BA, St. Louis University School of Medicine, St. Louis, MO.

MIGUEL PANIAGUA, MD, FACP, is an Associate Professor in the Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, and Director, Internal Medicine Residency Program, St. Louis University School of Medicine, St. Louis, MO.

ERIC S. ARMBRECHT, PhD, is an Assistant Professor, St. Louis University Center for Outcomes Research, St. Louis, MO.

View full text

Feature ArticlePatient Transfer Forms Enhance Key Information Between Nursing Homes and Emergency Department

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgment

J Am Med Dir Assoc

J Am Med Dir Assoc

The geriatric emergency department

J Am Geriatr Soc

Patient transfer from nursing home to emergency department: outcomes and policy implications

Acad Emerg Med

Relationship of long-term and acute-care facilities. The problem of patient transfer and continuity of care

J Am Geriatr Soc

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

J Am Geriatr Soc

Feature Article
Patient Transfer Forms Enhance Key Information Between Nursing Homes and Emergency Department