More than the diagnosis

As a long-time practising emergency physician, I would like to comment on the May 2009 article “Are long-term care residents referred appropriately to hospital emergency departments?”1 Jensen et al 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 for cases in which patients are unable to provide a thorough history owing to either their acute illness or dementia.

I have frequently seen patients sent to emergency departments with minimal amounts of information (eg, documentation does not mention how long the symptoms have been present, recent hospital discharge summaries are not included, results of physician examinations for the same problem are not present). In addition, transfer forms might not indicate whether the family has been called, and advanced directives might 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 often, by the time the patient is seen in the emergency department, the staff member who was responsible for initiating the transfer is off-duty and unavailable.

Future studies determining the appropriateness of transfers need to examine more than just the diagnoses of patients and whether or not they were admitted to hospital.

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