Relationship of long-term and acute-care facilities. The problem of patient transfer and continuity of care.

Approximately 17% of patients residing in an extended-care facility--which provides close physician-patient contact and strong affiliation with an acute-care hospital, although does not have the capacity for intravenous therapy--required admission to an acute-care hospital during a one-year period. The most common medical problem necessitating transfer to the acute-care hospital was an infectious process. Most infections were correctly diagnosed in the extended-care facility, but due to the inability to administer intravenous therapy, transfer was thought mandatory. The acute-care hospital stay was short, which is thought to reflect partially the close affiliation between the extended-care facility and acute-care hospital. Complications occurred while patients were in the acute-care hospital with 30% demonstrating new pressure sores upon their return to the extended-care facility. Repeated acute-care hospital admissions were not uncommon, usually occurring within a short period after the patient's return to the extended-care facility, and commonly related to the same medical disorder that caused the initial admission. Prognosis was poor in patients who required admission to the acute-care hospital and mortality rate increased to approximately 50% in patients requiring multiple admissions. It is concluded that an extended-care facility that provides a high level of physician-patient contact and a close affiliation with an acute-care hospital is advantageous in providing efficient and continual care for the elderly. Provisions for the administration of intravenous therapy might even increase the efficiency of such a facility.