Form Facilitates Nursing Home Transfers to ED

ACEP News
August 2010

By Damian McNamara
Elsevier Global Medical News

ORLANDO - A retrospective study found that a one-page transfer form increased the amount of essential information that emergency physicians received about patients coming from a nursing home.

Researchers reviewed randomly selected charts of 40 nursing home patients transferred with the form and the charts for another 40 residents transferred with no such documentation. They assessed 16 pieces of information that emergency physicians identified in previous studies as essential to optimally assess and treat transferred patients.

For nursing home residents transferred with the form, emergency physicians had an average 79% of the essential information, in contrast to 31% for the no-form group. The difference was statistically significant.

"We expected there to be a rise in the amount of pertinent information sent to the ER with use of transfer forms, but I was surprised by how considerable this increase was," researcher and medical student Vandana Vangimalla said in an interview at the annual meeting of the American Geriatrics Society.

The 16 essential elements were patient name, date of birth, reason for transfer, medical history, medications, allergies, baseline mental and physical functioning, code status, most recent vital signs, nursing home name, nursing home telephone number, power of attorney contact, family contact, physician name, physician phone number, and nursing home capabilities.

"Nursing homes should be using transfer forms, instead of [emergency physicians] searching for all this information," said Ms. Vangimalla, a student at Saint Louis University.

Obtaining adequate information on patients transferred from nursing homes can be a source of difficulty for ED personnel. Patients who present with little or no information can undergo unnecessary testing and waste valuable resources, Ms. Vangimalla said. The benefit of using a standard transfer form to improve communication has not been previously studied for this population, she said.

There was no difference in any of the secondary aims of the study, including time to hospital admission, discharge, or time to disposition. For example, disposition time was 145 minutes in the transfer-form group and 144 minutes in the no-form group.

All patients were older than 65 years and arrived at the Saint Louis University ED between January 2009 and June 2009.

The American Foundation for Aging Research funded the study. Ms. Vangimalla said she had no conflicts of interest to disclose.

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