Analysis of the impact of limitation of medical treatment orders during unplanned transfers from sub-acute care to emergency departments

Street, Maryann and Considine, Julie 2016, Analysis of the impact of limitation of medical treatment orders during unplanned transfers from sub-acute care to emergency departments, Australasian emergency nursing journal, vol. 19, no. 1, pp. 37-43, doi: 10.1016/j.aenj.2015.10.002.

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Title Analysis of the impact of limitation of medical treatment orders during unplanned transfers from sub-acute care to emergency departments
Author(s) Street, MaryannORCID iD for Street, Maryann orcid.org/0000-0002-5615-141X
Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
Journal name Australasian emergency nursing journal
Volume number 19
Issue number 1
Start page 37
End page 43
Total pages 7
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-02
ISSN 1574-6267
Keyword(s) Advance Directives
Clinical deterioration
Do-not-resuscitate orders
Emergency Departments
Patient transfer
Sub-acute care
Summary BACKGROUND: The impact of limitation of medical treatment orders (LOMT) on patient outcomes following transfer from sub-acute care to the Emergency Department remains unclear.

METHODS: Retrospective medical record review of 431 adult in-patients who required ambulance transfer following clinical deterioration during a sub-acute care admission during 2010.

RESULTS: Common reasons for transfer were respiratory (18.9%) or neurological (19.0%) conditions; 35.7% (154/431) were transferred within one week of sub-acute care admission. LOMT orders were in place for 37.8% (n=163) patients who were older (p<0.001), with more comorbidities (p<0.005), specifically cardiac, renal and pulmonary disease than patients without LOMT. Patients with LOMT orders had more physiological abnormalities before transfer; tachypnoea (43.7% vs 28.6%), hypoxaemia (63.5% vs 48.4%) and severe hypoxaemia (27.6% vs 14.5%). There were no differences in rates of admission, cardiac arrest, Medical Emergency Team activation or ICU admission. For admitted patients, those with LOMT orders had significantly (p≤0.005) higher mortality: in-hospital (21.9% vs 11.3%); 30 days (23.9% vs 12.3%) and 60 days (28.2% vs 13.4%).

CONCLUSIONS: Patients with LOMT had higher levels of comorbidity and were more acutely ill during their sub-acute care admission. Once transferred those with a LOMT had similar rates of cardiac arrest, MET activation and unplanned ICU admission, but higher mortality.
Language eng
DOI 10.1016/j.aenj.2015.10.002
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
1110 Nursing
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, College of Emergency Nursing Australasia
Persistent URL http://hdl.handle.net/10536/DRO/DU:30080177

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