Are long-term care residents referred appropriately to hospital emergency departments?

Phyllis Marie Jensen; Fred Fraser; Kanwal Shankardass; Ralph Epstein; Joginder Khera

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reply to Dr. J Lexchin
Frederick D Fraser

Published on: 28 May 2009
Appropriateness is more than the diagnosis
Joel Lexchin

Published on: 20 May 2009

Published on: (28 May 2009)
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reply to Dr. J Lexchin
Frederick D Fraser, physician
I thank Dr. Lexchin for his comments about our paper on patient transfer from LTC to the ER. Dr Lexchin highlights the importance of the referring facility sending some basic information with the patient. In the facility were I work,a brief narrative about the present illness and a medication list are routinely sent; the patient's family is informed about the transfer if they do not already know.All the hospitals in Hamilt...
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I thank Dr. Lexchin for his comments about our paper on patient transfer from LTC to the ER. Dr Lexchin highlights the importance of the referring facility sending some basic information with the patient. In the facility were I work,a brief narrative about the present illness and a medication list are routinely sent; the patient's family is informed about the transfer if they do not already know.All the hospitals in Hamilton are connected electronically so any previous admission data is available to the ER. Communication works both ways and patients are at times returned from the ER with no information. We all have an obligation to improve communication about this popululation of patients who can often not speak for themselves.
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Competing Interests: None declared.
Published on: (20 May 2009)
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Appropriateness is more than the diagnosis
Joel Lexchin, Emergency Physician
As a long-time practising emergency physician I would like to comment on the article by Jensen et al about whether residents of long-term care facilities are being appropriately referred to emergency departments. Jensen and her colleagues looked at one dimension of this issue but not at another – the quality of the documentation that is sent with patients. High quality information is always important but even more so wh...
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As a long-time practising emergency physician I would like to comment on the article by Jensen et al about whether residents of long-term care facilities are being appropriately referred to emergency departments. Jensen and her colleagues looked at one dimension of this issue but not at another – the quality of the documentation that is sent with patients. High quality information is always important but even more so when patients are unable to provide a good history either because of their acute illness or due to dementia.
I have frequently seen patients sent with minimal amounts of information, e.g., no mention of how long the symptoms were present, no recent hospital discharge summaries, no results of physician examination for the same problem. In addition, transfer forms may not indicate whether or not the family has been called and advanced directives may have been signed years ago and not updated. This lack of high quality documentation means time spent on the telephone trying to get the necessary information from the facility and frequently by the time the patient is seen in the emergency department the staff who were responsible for initiating the transfer are off- duty and unavailable.
Future work looking at the appropriateness of transfers needs to examine more than just the patient’s diagnosis and whether or not they were admitted to hospital.
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Competing Interests: None declared.