File(s) under permanent embargo

Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: a multi‐site prospective cohort study

Aims and objectives

To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter‐hospital transfer from a subacute to an acute care hospital.


Background

Patients who experience emergency inter‐hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in‐hospital mortality (15%).


Design

This prospective, exploratory cohort study was a subanalysis of data from a larger case–time–control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines.


Methods

Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not‐for‐cardiopulmonary resuscitation (CPR) orders) were compared using chi‐square or Kruskal–Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect.


Findings.

Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not‐for‐CPR. Compared to patients for full resuscitation, patients with not‐for‐CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not‐for‐CPR were less likely to be readmitted to acute care and more likely to return to subacute care.


Conclusions

Two‐thirds of patients in subacute care who experienced an emergency inter‐hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not‐for‐CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients.


Relevance to Clinical Practice

As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.

History

Journal

Journal of clinical nursing

Volume

29

Issue

7-8

Pagination

1302 - 1311

Publisher

Wiley

Location

Chichester, Eng.

ISSN

0962-1067

eISSN

1365-2702

Language

eng

Publication classification

C1 Refereed article in a scholarly journal