Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Australia.
Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Australia.
Int J Nurs Stud. 2019 Mar;91:77-85. doi: 10.1016/j.ijnurstu.2018.12.008. Epub 2019 Jan 2.
Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors.
To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. The investigators defined early transfers as occurring within 1 day and late transfers occurring after 1 day after subacute care admission.
This prospective, exploratory cohort study is a subanalysis of data from a larger case-time-control study.
Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services' acute care hospitals.
All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management wards to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded.
Data were collected between 22 August 2015 and 30 October 2016 by record audit. To compare patient and admission characteristics between early and late transfers Cochran-Mantel-Haenszel test (CMH) or logistic regression were used to account for health service clustering effect.
There were 602 transfers: 54 early (48 patients) and 548 late transfers (505 patients). There was no difference in median age (79.5 vs 80, p = 0.680) or Charlson Comorbidity index (both groups = 3, p = 0.933). Early transfer patients had lower functional independence measure scores on subacute care admission (median 45 vs 66, p < 0.001). Prior to transfer, fewer early transfers had a limitation of medical treatment order in place during their subacute care admission (25.9% vs 48.7%, p < 0.001). The majority of both early and late transfers resulted in acute care hospital readmission (85.1% vs 77.7%, p = 0.204). For patients admitted to acute care, there was no difference in median acute care length of stay (6.5 vs 8 days, p = 0.367). Early transfer patients had fewer in-hospital deaths than late transfer patients (3.8% vs 16.1%, p = 0.004).
The high rates of acute care readmission in both groups suggest that transfer was warranted. Early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to have a safety benefit. Early transfer patients were less likely than late transfer patients to have limitation of medical treatment orders, so the influence of resuscitation status and patient goals of care on transfer decisions warrants further investigation.
澳大利亚和国际数据表明，每 10 名住院康复患者中就有 1 人会转入急性护理医院。亚急性护理向急性护理医院的早期非计划性转移引发了对患者在卫生部门之间转移安全的质疑。
探讨亚急性护理向急性护理医院的早期和晚期紧急院内转科的特征。研究人员将早期转科定义为入院后 1 天内发生的转科，晚期转科定义为入院后 1 天以后发生的转科。
这是一项前瞻性探索性队列研究，是对一项更大的病例时间对照研究数据的亚分析。
澳大利亚维多利亚州五个主要卫生服务机构的 8 家亚急性护理医院的 22 个病房。所有亚急性护理医院都与所属卫生服务机构的急性护理医院在地理位置上分开。
所有从康复病房或老年评估和管理病房紧急转入同一卫生服务机构的急性护理医院的患者均被纳入研究。接受姑息治疗的患者被排除在外。
数据通过记录审核于 2015 年 8 月 22 日至 2016 年 10 月 30 日期间收集。为了比较早期和晚期转科患者的特征，采用 Cochran-Mantel-Haenszel 检验（CMH）或逻辑回归来解释卫生服务聚类效应。
共发生 602 次转科：54 次早期（48 例）和 548 次晚期（505 例）。中位年龄（79.5 岁比 80 岁，p=0.680）或 Charlson 合并症指数（两组均为 3，p=0.933）无差异。亚急性护理入院时，早期转科患者的功能独立性测量评分较低（中位数 45 比 66，p<0.001）。在转科前，早期转科患者的亚急性护理入院期间接受医疗限制治疗医嘱的比例较低（25.9%比 48.7%，p<0.001）。大多数早期和晚期转科患者都需要再次入住急性护理医院（85.1%比 77.7%，p=0.204）。对于入住急性护理医院的患者，急性护理住院时间的中位数无差异（6.5 天比 8 天，p=0.367）。早期转科患者的院内死亡率低于晚期转科患者（3.8%比 16.1%，p=0.004）。
两组患者的急性护理再入院率均较高，这表明转科是合理的。早期转科患者的住院死亡率较低，因此紧急院内转科虽然资源密集，但似乎具有安全性优势。与晚期转科患者相比，早期转科患者不太可能下达医疗限制治疗医嘱，因此复苏状态和患者的治疗目标对转科决策的影响值得进一步研究。
