The Physician Decision-Making Process in Transferring Nursing Home Patients to the Hospital

Abstract

In this sample of acutely ill nursing home patients, physicians collected limited clinical data before the decision to transfer. Although some transfers may be appropriate, a reduction in the transfer rate may reduce health care costs and limit the risk of iatrogenesis, thus improving the outcome of acute illnesses occurring in the nursing home.

Dying in U.S. Nursing Homes with Advanced Dementia: How Does Health Care Use Differ for Residents with, versus without, End-of-Life Medicare Skilled Nursing Facility Care?

“…Similar routine intervention does not occur for many nonhospice residents who become acutely ill, or are actively dying. 33,34 So, in addition to the palliative care expertise that accompanies hospice enrollment, care protocols associated with hospice enrollment appear to enable the avoidance of EoL hospitalization.…”

Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety

“…The staff at each institution's "transfer center" then contacts key stakeholders (e.g., referring and accepting physician, bedside nurses, etc.) so that the receiving physician is fully aware of the patient's condition and any other information pertinent to the situation in order to determine the appropriateness of the proposed transfer, assess patient suitability for transfer in the context of available clinical data, allocate appropriate level-of-care resources (e.g., ICU bed, operating room), and finalize the decision on transfer modality (e.g., ground versus air transport) [41,42]. Not only is it necessary for the referring and accepting physicians to be in close contact and discuss the transfer and any potential challenges, but it is also critical for the nurses from the receiving and transferring facilities to communicate details of care pertaining to the patient [43,44].…”

The Institutional Practice

“…Even though definitions of what constitutes a hospitalization differ or are absent (Castle & Mor 1996), research articles still refer to overall numbers for hospitalizations. Typically these are overall average rates within a given geographical area (Ibid., Grabowski et al 2008, Brooks et al 1994, Godden & Pollock 2001, Graverholt et al 2011, Stephens et al 2011. To simplify, two literature reviews can be used, supplemented by a governmental report to illustrate how rates of hospitalization are presented.…”

“…Research about the decision making process relating to hospitalization is substantial in terms of the number of articles addressing the topic, both in the qualitative literature and other segments (Brooks et al 1994, Cohen-Mansfield et al 2003a, Cohen-Mansfield et al 2003b, Cohen-Mansfield & Lipson 2006, Flacker et al 2001). This research, however, rarely incorporates analyses of decisions not resulting in a hospitalization.…”

“…The «rule» of physicians' presence in nursing homes being a fixed entity at Norwegian nursing homes (Graverholt et al 2013) is, for instance, a rule which can be bent and interpreted differently. 6 An exception to this tendency is a subtheme dealing with communication between NHs and hospitals/ emergency wards (Brooks et al 1994, Cheng et al 2006, Coleman 2003, Coleman & Berenson 2004, Cwinn et al 2009, Parry et al 2003. Within this subtheme, the focus is on processes influencing hospitalizations, rather than specific factors.…”