Department of Emergency Medicine, Brown University, Providence, RI.
Department of Emergency Medicine, Brigham & Women's Hospital, Harvard University, Boston, MA.
J Am Med Dir Assoc. 2019 Aug;20(8):935-941.e3. doi: 10.1016/j.jamda.2018.09.008. Epub 2018 Oct 29.
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).
CONCLUSIONS/IMPLICATIONS: 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.
急诊科（ED）临床医生在评估养老院（NH）居民的需求时依赖于书面交流的准确性。本研究旨在根据 INTERACT 4.0 质量改进工具，按照预期的核心内容审查 NH 转科文件的完整性。我们还描述了患者或医疗机构特征与转科文件完整性之间的关联，并确定 NH-ED 转科文件中的信息空白是否与住院相关。
使用 2 名对研究目的不知情的摘要员进行的回顾性研究。
2015 年 9 月至 2016 年 9 月，从罗德岛最大的医疗保健系统的 3 个 ED 转来的 474 名 NH 居民的记录。
根据 INTERACT 4.0 质量改进工具，按照转科文件的预期核心项目审查 NH-ED 转科文件的完整性。我们使用具有随机效应的多变量线性回归来评估与 NH-ED 转科文件完成相关的因素，并使用具有随机效应的逻辑回归来评估信息空白与住院之间的关系。
在 474 次 NH-ED 转科就诊中，患者平均年龄为 76 岁；43%为男性，14%为非裔美国人，34%患有痴呆症。97%的就诊都有 NH-ED 转科文件，15 项 INTERACT 核心项目中有 11.9 项是完整的。75%的患者通常的精神状态和转科原因缺失，而 80%的患者功能状态缺失。多变量模型显示，Charlson 合并症指数评分较高（系数为 0.08，标准误差为 0.04，P=0.03）与更完整的记录相关。更完整的记录与更高的住院可能性相关（调整后的优势比=1.09，95%置信区间=1.01-1.18）。
结论/意义：NH-ED 转科文件中通常缺少通常的精神和功能状态以及转科原因，应将其纳入标准化转科表格。
