Transfers to hospital for assessment and treatment of a change in condition have become customary. However, they are often of uncertain benefit, and may result in increased morbidity. In one Canadian study, 47% of hospitalizations were considered avoidable, while a recent US study found 39% to be ‘potentially avoidable’. Transfer often results in long periods in an unfamiliar and stressful environment for the patient. Other hazards include delirium, hospital acquired infections, medication side effects, lack of sleep, and rapid loss of muscle strength while bedridden. Harms often outweigh benefits. Residents assessed and treated at their care home will receive more individualized care, better comfort and end of life care. If a transfer is unavoidable, give clear prior instructions to the hospital of the patient’s needs. Respect for patient choice is a fundamental consideration in all decisions to transfer to a hospital. A clear understanding of the patient’s goals must be established taking into account current health status, values and preferences. This will reduce the likelihood of inappropriate transfer. These goals should be discussed earlier and often with the patient and family, including whether comfort, function and quality of life are their most important goals.
Sources:
Walker JD, et al. Identifying potentially avoidable hospital admissions from Canadian long-term care facilities. Med Care. 2009 Feb;47(2):250-4. PMID: 19169127.
Walsh EG, et al. Potentially avoidable hospitalizations of dually eligible Medicare and Medicaid beneficiaries from nursing facility and Home- and Community-Based Services waiver programs. J Am Geriatr Soc. 2012 May;60(5):821-9. PMID: 22458363.