Appropriateness of the decision to transfer nursing facility residents to the hospital
Appropriateness of the decision to transfer nursing facility residents to the hospital
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DOI：
10.1111/j.1532-5415.2000.tb03906.x
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发表时间：
2000-02-01
影响因子：
6.3
通讯作者：
Rubenstein, L
中科院分区：
文献类型：
--
作者：
Saliba, D;Kington, R;Rubenstein, L
目的：开发和测试一个标准化的工具，其目的是评估（1）是否熟练的护理机构（SNF）转移居民到急诊科（艾德）不适当，（2）是否居民被接纳到医院不适当，（3）和相关因素不适当的转移。设计：结构化的隐式审查（SIR）的医疗记录。使用嵌套随机抽样在8个社区SNF，我们确定了SNF和100个计划外转移到10 hospital.MEASUREMENTS之一的医院记录：七个训练有素的医生审查评估适当使用SIR形式设计的这项研究（2个独立的审查每记录，200总评论）。我们测量评估者间的可靠性与Kappa统计，并采用双变量分析，以确定与评估相关的因素，转让是不适当的。结果：在36%的艾德转让和40%的住院，两个评论家都同意，转让/承认是不适当的，这意味着居民可以得到安全的照顾，在较低的护理水平。艾德（一致率84%，kappa. 678）和医院（一致率89%，kappa. 779）的一致性都很高。当考虑到预先指示时，两位评审员都认为44%的艾德转移和45%的入院不合适。不适当的相关因素包括的看法，即：（1）质量差的护理转移需要，（2）所需的服务，通常可以在门诊设置，（3）的主要投诉并不保证住院治疗。结论：不适当的转让是一个潜在的大问题。一些不适当的转移可能与SNF的护理质量差有关。这项研究表明，结构化的内隐审查符合标准的不适当的转移率的可靠评估。结构化的隐性审查可能是一个有价值的工具，用于识别从SNF到ED和医院的不适当转移。
OBJECTIVES: To develop and test a standardized instrument, the purpose of which is to assess (1) whether skilled nursing facilities (SNFs) transfer residents to emergency departments (ED) inappropriately, (2) whether residents are admitted to hospitals inappropriately, (3) and factors associated with inappropriate transfers.DESIGN: A structured implicit review (SIR) of medical records.SETTING AND PARTICIPANTS: Using nested random sampling in eight community SNFs, we identified SNF and hospital records of 100 unscheduled transfers to one of 10 hospitals.MEASUREMENTS: Seven trained physician reviewers assessed appropriateness using a SIR form designed for this study (2 independent reviews per record, 200 total reviews). We measured interrater reliability with kappa statistics and used bivariate analysis to identify factors associated with assessment that transfer was inappropriate.RESULTS: In 36% of ED transfers and 40% of hospital admissions, both reviewers agreed that transfer/admit was inappropriate, meaning the resident could have been cared for safely at a lower level of care. Agreement was high for both ED (percent agreement 84%, kappa .678) and hospital (percent agreement 89%, kappa .779). When advance directives were considered, both reviewers rated 44% of ED transfers and 45% of admissions inappropriate. Factors associated with inappropriateness included the perceptions that: (1) poor quality of care contributed to transfer need, (2) needed services would typically be available in outpatient settings, and (3) the chief complaint did not warrant hospitalization.CONCLUSIONS: Inappropriate transfers are a potentially large problem. Some inappropriate transfers may be associated with poor quality of care in SNFs. This study demonstrates that structured implicit review meets criteria for reliable assessment of inappropriate transfer rates. Structured implicit review may be a valuable tool for identifying inappropriate transfers from SNFs to EDs and hospitals.