Kerr H D, Byrd J C
Division of General Internal Medicine, Zablocki VA Medical Center, Milwaukee, Wisconsin 53295.
J Am Geriatr Soc. 1991 Feb;39(2):132-6. doi: 10.1111/j.1532-5415.1991.tb01614.x.
Nursing home residents are frequently transferred to hospital emergency departments. Delayed transfer may lead to poor outcomes. However, inappropriate transfer of the frail elderly may cause social and financial problems. We prospectively evaluated 221 consecutive ambulance transfers from community nursing homes to a VA emergency department. The objectives of the study were to describe the process and outcomes of transferred patients and to determine if alternative interventions were feasible. The results indicate that the problems of nearly half the study group could have been treated at the nursing home by a visiting physician with minimal medical equipment. Those admitted to the hospital (52%) were seriously ill, had prolonged lengths of stay (23.6 days), and had a high mortality rate (11%). Complex issues of physician reimbursement, proprietary nursing home budgeting, and day-to-day expediency appear to be involved in decisions to transport patients by ambulance to VA emergency departments.
养老院居民经常被转送到医院急诊科。延迟转运可能导致不良后果。然而，体弱老年人的不适当转运可能会引发社会和经济问题。我们对221例从社区养老院连续转运至退伍军人事务部（VA）急诊科的病例进行了前瞻性评估。该研究的目的是描述转运患者的过程和结果，并确定替代干预措施是否可行。结果表明，近一半研究组患者的问题本可由配备最少医疗设备的出诊医生在养老院进行治疗。入院的患者（52%）病情严重，住院时间延长（23.6天），死亡率较高（11%）。医生报销、养老院专有预算以及日常便利性等复杂问题似乎与通过救护车将患者转运至VA急诊科的决策有关。
