Jones J S, Dwyer P R, White L J, Firman R
Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, MI 49503, USA.
Acad Emerg Med. 1997 Sep;4(9):908-15. doi: 10.1111/j.1553-2712.1997.tb03818.x.
To describe the process and outcomes of nursing home (NH) residents transferred to hospital EDs.
This was a prospective, observational study conducted at 2 Midwestern community teaching hospitals during a 12-month period. All elder patients (> 64 years of age) transferred to hospital EDs from regional NHs were eligible for the study. Hospital records were used to abstract relevant descriptive and clinical data. Need for ambulance use was graded prospectively using 3 categories of urgency developed in other studies. Transfers were considered "appropriate" based on outcome measures or if the problem necessitated diagnostic and/or therapeutic procedures not available in the NH. Transfer documentation was evaluated using a standardized 18-item checklist.
A total of 709 consecutive NH patients made 1,012 ED visits. Their mean age was 83.4 years (range 65-100); 76% were female. The majority of patients (94%) were transferred by ambulance. Ambulance transfer was classified as emergent (16% of patients), urgent (45%), or routine (39%). There were 319 (45%) patients subsequently admitted to the hospital. Approximately 77% (546/709) of the NH transfers were considered appropriate by the emergency physician (EP). Sixty-seven patients (10%) were transferred without any documentation. For those patients with transfer documentation, 6 common discrepancies were identified.
Although the majority of NH transfers in this population were appropriate, many patients were transferred without adequate documentation for the EP.
描述转至医院急诊科的疗养院（NH）居民的过程及结果。
这是一项前瞻性观察性研究，在2家中西部社区教学医院进行，为期12个月。所有从地区NH转至医院急诊科的老年患者（>64岁）均符合研究条件。利用医院记录提取相关描述性和临床数据。前瞻性地使用其他研究制定的3类紧急程度对使用救护车的需求进行分级。根据结果指标或如果问题需要NH无法提供的诊断和/或治疗程序，则认为转院是“适当的”。使用标准化的18项检查表对转院文件进行评估。
共有709例连续的NH患者前往急诊科就诊1012次。他们的平均年龄为83.4岁（范围65 - 100岁）；76%为女性。大多数患者（94%）通过救护车转院。救护车转院被分类为紧急（16%的患者）、 urgent（45%）或常规（39%）。随后有319例（45%）患者入院。约77%（546/709）的NH转院被急诊医生（EP）认为是适当的。67例患者（10%）转院时没有任何文件记录。对于有转院文件记录的患者，发现了6个常见差异。
尽管该人群中大多数NH转院是适当的，但许多患者转院时没有为EP提供充分的文件记录。
