Considine Julie, Street Maryann, Botti Mari, O'Connell Bev, Kent Bridie, Dunning Trisha
Eastern Health, Deakin University Nursing & Midwifery Research Centre, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research, 221 Burwood Hwy, Burwood, Vic. 3125, Australia. Email.
Epworth Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research. Email.
Aust Health Rev. 2015 Sep;39(4):387-394. doi: 10.1071/AH14106.
The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care.
Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of subacute care admission.
In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of subacute care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01).
There is a high rate of unplanned transfers to acute care within 24h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates.
本研究旨在调查需要从亚急性护理意外转至急性护理的患者的转院时机及转归情况。
纳入2010年1月1日至12月31日期间在维多利亚州四家医疗服务机构中需要从亚急性护理意外转至急性护理机构的住院患者。采用回顾性审计收集数据。主要结局为在亚急性护理入院后24小时内转院。
共有431例患者（中位年龄81岁）发生意外转院；其中，37.8%的患者有医疗治疗限制（LOMT）医嘱。亚急性护理的中位住院时间为43小时：29.0%的患者在亚急性护理入院后24小时内转院，83.5%的患者在亚急性护理入院后72小时内转院。24小时内转院的预测因素为合并症加权（比值比（OR）1.1，P = 0.02）和LOMT医嘱（OR 2.1，P < 0.01）。87.2%的患者入院治疗，15.4%的患者在医院死亡。院内死亡的预测因素为合并症加权（OR 1.2，P < 0.01）和转院前24小时内生理异常的数量（OR 1.3，P < 0.01）。
亚急性护理入院后24小时内意外转至急性护理的发生率很高。意外转院与高入院率和院内死亡率相关。
