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Prevalence of information gaps for seniors transferred from nursing homes to the emergency department

Published online by Cambridge University Press:  21 May 2015

Matthew A. Cwinn ,
Alan J. Forster ,
A. Adam Cwinn ,
Guy Hebert ,
Lisa Calder  and
Ian G. Stiell
Matthew A. Cwinn*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Alan J. Forster
Affiliation:
Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont.
A. Adam Cwinn
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Guy Hebert
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Lisa Calder
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
*
Department of Emergency Medicine, Rm. M2389-G, The Ottawa Hospital, 501 Smyth Rd., Ottawa ON K1H 8L6; [email protected]

Abstract

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Objective:

Information gaps, defined as previously collected information that is not available to the treating physician, have implications for patient safety and system efficiency. For patients transferred to an emergency department (ED) from a nursing home or seniors residence, we determined the frequency and type of clinically important information gaps and the impact of a regional transfer form.

Methods:

During a 6-month period, we studied consecutive patients who were identified through the National Ambulatory Care Reporting System database. Patients were over 60 years of age, lived in a nursing home or seniors residence, and arrived by ambulance to a tertiary care ED. We abstracted data from original transfer and ED records using a structured data collection tool. We measured the frequency of prespecified information gaps, which we defined as the failure to communicate information usually required by an emergency physician (EP). We also determined the use of the standardized patient transfer form that is used in Ontario and its impact on the rate of information gaps that occur in our community.

Results:

We studied 457 transfers for 384 patients. Baseline dementia was present in 34.1% of patients. Important information gaps occurred in 85.5% (95% confidence interval [CI] 82.0%–88.0%) of cases. Specific information gaps along with their relative frequency included the following: the reason for transfer (12.9%), the baseline cognitive function and communication ability (36.5%), vital signs (37.6%), advanced directives (46.4%), medication (20.4%), activities of daily living (53.0%) and mobility (47.7%). A standardized transfer form was used in 42.7% of transfers. When the form was used, information gaps were present in 74.9% of transfers compared with 93.5% of the transfers when the form was not used (p < 0.001). Descriptors of the patient's chief complaint were frequently absent (81.0% for head injury [any information about loss of consciousness], 42.4% for abdominal pain and 47.1% for chest pain [any information on location, severity and duration]).

Conclusion:

Information gaps occur commonly when elderly patients are transferred from a nursing home or seniors residence to the ED. A standardized transfer form was associated with a limited reduction in the prevalence of information gaps; even when the form was used, a large percentage of the transfers were missing information. We also determined that the lack of descriptive detail regarding the presenting problem was common. We believe this represents a previously unidentified information gap in the literature about nursing home transfers. Future research should focus on the clinical impact of information gaps. System improvements should focus on educational and regulatory interventions, as well as adjustments to the transfer form.

Keywords

emergency departmentinformation gapspatient transfersnursing homespatient safetygeriatrics
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 5 , September 2009 , pp. 462 - 472
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

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