Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration

Abstract

Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.

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

“…This prospective, exploratory cohort study is a subanalysis of data derived from a larger case–time–control study (Considine et al, ). The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines (von Elm et al, ) (see Supplementary File 1).…”

“…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. (Considine et al, 2019).…”

“…Patients who experience an emergency inter‐hospital transfer from a subacute care to an acute care hospital often (76%) require ED care, have high rates of acute care readmission (81%) and 15% die during the same episode of hospitalisation. This raises questions about whether ambulance transfer, ED care and acute care readmission are the appropriate response to clinical deterioration in patients in subacute care hospitals (Considine et al, ).…”

“…There is a large body of knowledge regarding recognising and responding to clinical deterioration in patients located in acute care hospitals (Jones, 2014;Jones, Bhasale, Bailey, Pilcher, & Anstey, 2018;Jones, Dunbar, & Bellomo, 2012b;Jones, Mitchell, Hillman, & Story, 2013); however, clinical deterioration of patients located in subacute care hospitals is not well understood. Subacute care includes rehabilitation or geriatric evaluation and management (GEM) (also called slow stream rehabilitation) and is multidisciplinary care (Considine, Mohr, Lourenco, Cooke, & Aitken, 2013;Considine et al, 2019). Patients who experience an emergency inter-hospital transfer from a subacute care to an acute care hospital often (76%) require ED care, have high rates of acute care readmission (81%) and 15% die during the same episode of hospitalisation.…”

“…This raises questions about whether ambulance transfer, ED care and acute care readmission are the appropriate response to clinical deterioration in patients in subacute care hospitals (Considine et al, 2019).…”