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Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Considine, Julie, Street, Maryann, Botti, Mari, O'Connell, Bev, Kent, Bridie and Dunning, Trisha 2015, Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care, Australian health review, vol. 39, no. 4, pp. 387-394, doi: 10.1071/AH14106.

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Title Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care
Author(s) Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
Street, MaryannORCID iD for Street, Maryann orcid.org/0000-0002-5615-141X
Botti, MariORCID iD for Botti, Mari orcid.org/0000-0002-2782-0987
O'Connell, Bev
Kent, Bridie
Dunning, TrishaORCID iD for Dunning, Trisha orcid.org/0000-0002-0284-1706
Journal name Australian health review
Volume number 39
Issue number 4
Start page 387
End page 394
Total pages 8
Publisher CSIRO Publishing
Place of publication Melbourne, Vic
Publication date 2015
ISSN 1449-8944
0159-5709
Keyword(s) clinical deterioration
patient safety
rapid response
risk response
risk management
transitions in care
Summary Objective The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care. Methods Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24h of subacute care admission. Results In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43h: 29.0% of patients were transferred within 24h and 83.5% were transferred within 72h of subacute care admission. Predictors of transfer within 24h were comorbidity weighting (odds ratio (OR) 1.1, P≤0.02) and LOMT order (OR 2.1, P<0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P<0.01) and the number of physiological abnormalities in the 24h preceding transfer (OR 1.3, P<0.01). Conclusions There is a high rate of unplanned transfers to acute care within 24h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates. What is known about the topic? Subacute care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute care, but still developing in subacute care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in subacute care facilities. One-third of unplanned transfers occur within 24h of admission to subacute care. Patients who require unplanned transfer from subacute to acute care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in subacute care settings.
Language eng
DOI 10.1071/AH14106
Field of Research 111099 Nursing not elsewhere classified
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2015, CSIRO Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30073517

Document type: Journal Article
Collections: School of Nursing and Midwifery
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.