Considine Julie, Mohr Marie, Lourenco Rosemary, Cooke Robynne, Aitken Mark
School of Nursing and Midwifery, Deakin University, Victoria, Australia.
Int J Nurs Pract. 2013 Apr;19(2):186-96. doi: 10.1111/ijn.12056.
The study aims to identify the reasons for, and outcomes from, unplanned transfers from subacute care to acute care. A retrospective patient record review of patients requiring unplanned transfer from subacute to an acute care emergency department (ED) from 1 July 2008 to 30 June 2009 was undertaken. Data collected included patient demographics, clinical characteristics in preceding transfer, and on ED arrival and outcome data. There were 136 patients included in the study with a median age of 81 years. The most common reasons for transfer were respiratory problems and altered conscious state. In the 24 h preceding transfer, 92.6% of patients had ≥ 1 physiological abnormality and 10.3% of patients had no physiological parameters documented. On ED arrival, 75% of patients had physiological abnormalities. Hospital admission occurred in 75% of patients and the inpatient mortality rate was 14.7%. Factors associated with inpatient mortality were tachypnoea and severe hypoxaemia in 24 h preceding transfer and tachypnoea, hypoxaemia, hypoxaemia, severe hypoxaemia and hypothermia on ED arrival. Patients requiring unplanned transfer had higher inpatient mortality than older hospital users. Reasons for unplanned transfer reflect known predictors of in-hospital adverse events so predictive use of physiological data and patient characteristics might optimize patient safety.
该研究旨在确定亚急性护理向急性护理非计划转诊的原因及结果。对2008年7月1日至2009年6月30日期间需要从亚急性护理非计划转诊至急性护理急诊科（ED）的患者进行了回顾性病历审查。收集的数据包括患者人口统计学信息、转诊前的临床特征、到达急诊科时的情况以及结果数据。该研究纳入了136例患者，中位年龄为81岁。最常见的转诊原因是呼吸问题和意识状态改变。在转诊前24小时内，92.6%的患者有≥1项生理异常，10.3%的患者没有记录生理参数。到达急诊科时，75%的患者有生理异常。75%的患者住院治疗，住院死亡率为14.7%。与住院死亡率相关的因素是转诊前24小时内的呼吸急促和严重低氧血症，以及到达急诊科时的呼吸急促、低氧血症、严重低氧血症和体温过低。需要非计划转诊的患者的住院死亡率高于老年住院患者。非计划转诊的原因反映了已知的院内不良事件预测因素，因此对生理数据和患者特征进行预测性应用可能会优化患者安全。
