Referral of Patients from Long‐term to Acute‐care Facilities

Abstract

Medical care available to residents of nursing homes and chronic-care hospitals was assessed by studying transfers of such persons to the emergency room of an acute-care hospital. Patients (100) transferred from nursing homes and 16 patients transferred from chronic-care hospitals were compared with 338 elderly patients from home (control group). Elevated temperature (.gtoreq. 102.degree. F) was found in 17.3% of nursing home patients and 30.0% of chornic-case hospital patients, compared with 1.8% of controls (P < 0.05); mental status abnormalities were found in 66.1% of patients from nursing homes and in 90.9% of those from chronic-care hospitals, compared with 36.2% controls (P < 0.025). Patients from chronic-care hospitals, but not those from nursing homes, often showed substantial abnormalities of blood pressure and pulse. Patients from nursing homes tended to be slightly sicker than controls, and those from chronic-care hospitals considerably sicker. The probability of requiring admission to the hospital was the same for residents of nursing homes and persons living at home (44.0% and 43.2% respectively), but was higher for persons from chronic-care hospitals (81.3%, P < 0.005). It was also determined whether a disproportionately large percentage of transfers from extended-care facilities occurred at night or on weekends. Among nursing home patients, 12.6% of emergency room visits occurred on weekends, compared with 20.0% of chronic-care hospital patients and 24.3% of controls. Dumping of patients was not found. Utilization of a hospital emergency room by nursing home patients is very similar to that by home residents, suggesting an inadequacy of on-site medical services; that by chronic-care hospital patients is restricted to major illness, which is entirely appropriate.