Repeated Hospital Transfers and Associated Outcomes by Residency Time Among Nursing Home Residents in Taiwan

Abstract

Background : Nursing home residents` repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents’ symptoms over their nursing home residency and its relationship to hospital transfer. Aim : The purpose of this retrospective chart-review study was to examine associations between nursing home residents’ characteristics, including length of residency, and repeated hospital transfers as well as the trajectory of transfers during residency. Design : For this retrospective study, we reviewed 583 residents’ charts in 6 randomly selected nursing homes from northern Taiwan. Data were analyzed by descriptive statistics, chi-squared tests, and 1-way analysis of variance. Results : About half of nursing home residents who had been transferred to hospital (n = 320) were transferred more than twice during their residency (50.97%). Residents who had been transferred 1, 2, 3, or ≥4 times differed significantly in length of residency (F = 3.85, P = .01), physical status (F = 2.65, P = .05), medical history of pneumonia (χ2 = 13.03, P = .01), and fractures (χ2 = 8.52, P = .04). Residents with different numbers of transfers differed significantly in their reasons for transfer, that is, falls (χ2 = 13.01, P = .01) and tube problems (χ2 = 8.87, P = .03). Among 705 total transfers, fever was the top reason for transfer, and transfer prevalence increased with nursing home residency. Conclusion : To decrease the chance of residents’ hospital transfer, nursing home staff should be educated about recognizing and managing fever symptoms, infection-control programs such as influenza vaccination should be initiated, and fall-prevention/education programs should be started when residents first relocate to nursing homes.