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Characteristics and outcomes of patients requiring unplanned transfer from subacute to acute care

Authors

  • Julie Considine RN RM BN EmergCert GDipNurs GCertHigherEd MNurs PhD FRCNAAssoicate,

    Professor, Deakin University—Northern Health Clinical Partnership, Corresponding author
    • School of Nursing and Midwifery, Deakin University, Victoria, Australia
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  • Marie Mohr RN RM BN GDipAdvNurs (Admin),

    Director of Nursing/Inpatients Operations Manager/Site Manager
    1. Broadmeadows Health Service, Northern Health, Victoria, Australia
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  • Rosemary Lourenco RN BN,

    Registered Nurse, Geriatric Evaluation and Management Unit
    1. Broadmeadows Health Service, Northern Health, Victoria, Australia
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  • Robynne Cooke RN BN GDipGeront MHSM MRCNA,

    Chief Nursing Officer/Executive Director
    1. Medical and Continuing Care Services, Northern Health, Victoria, Australia
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  • Mark Aitken RN BA GDipNursMgmt DipSexualHealthCouns DipFamilyPlanning CertIVWorkplaceTrainingAssessment

    Director of Nursing and Inpatient Services
    1. Bundoora Extended Care Centre, Northern Health, Victoria, Australia
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  • Funding: This study was generously funded by a Northern Health small research grant.
  • Conflicts of interest: None.
  • Author contributions: JC and MM conceived the study and designed the trial. MM, JC, RL and RC obtained research funding. JC, MM and RC supervised the conduct of the trial and data collection. RL collected the study data. JC analysed the study data. JC drafted the manuscript, and all authors contributed substantially to its revision. JC takes responsibility for the paper as a whole.

Correspondence: Julie Considine, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: julie.considine@deakin.edu.au

Abstract

The study aims to identify the reasons for, and outcomes from, unplanned transfers from subacute care to acute care. A retrospective patient record review of patients requiring unplanned transfer from subacute to an acute care emergency department (ED) from 1 July 2008 to 30 June 2009 was undertaken. Data collected included patient demographics, clinical characteristics in preceding transfer, and on ED arrival and outcome data. There were 136 patients included in the study with a median age of 81 years. The most common reasons for transfer were respiratory problems and altered conscious state. In the 24 h preceding transfer, 92.6% of patients had ≥ 1 physiological abnormality and 10.3% of patients had no physiological parameters documented. On ED arrival, 75% of patients had physiological abnormalities. Hospital admission occurred in 75% of patients and the inpatient mortality rate was 14.7%. Factors associated with inpatient mortality were tachypnoea and severe hypoxaemia in 24 h preceding transfer and tachypnoea, hypoxaemia, hypoxaemia, severe hypoxaemia and hypothermia on ED arrival. Patients requiring unplanned transfer had higher inpatient mortality than older hospital users. Reasons for unplanned transfer reflect known predictors of in-hospital adverse events so predictive use of physiological data and patient characteristics might optimize patient safety.

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