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Discrepancy between information provided and information required by emergency physicians for long-term care patients

  • Richa Parashar (a1), Shelley McLeod (a1) (a2) and Don Melady (a1) (a2)

Abstract

Objectives

The primary objective of this study was to identify information included in long-term care (LTC) transfer documentation and to compare it to the information required by local emergency department (ED) physicians to provide optimal care and make decisions for LTC patients.

Methods

A retrospective chart review was conducted for a sample of LTC residents transferred by ambulance to the ED of an academic, tertiary care hospital over a 1-year period. All emergency physicians working at the institution were invited to complete an online questionnaire about information included in LTC transfer documentation and information required by emergency physicians to provide care for LTC patients.

Results

Of the 200 charts reviewed, the most common information transferred to the ED with the LTC patient was the patient’s past medical history (n=184, 92.0%), name of family physician (n=182, 91.0%), a list of known allergies (n=179, 89.5%), the reason for transfer to the ED (n=155, 77.5%), the patient’s emergency contact information (n=152, 76.0%), and medication administration record (n=150, 75.0%). From a physician’s perspective, the most frequently requested pieces of information included reason for transfer, past medical history, cognitive status, advanced directives for level of care and resuscitation, and the patient’s emergency contact information. This information was provided 77.5% (n=155), 92.0% (n=184), 24.0% (n=48), 62.0% (n=124), and 76.0% (n=152) of the time, respectively.

Conclusions

Our study demonstrates a clear discrepancy between information provided and information required by emergency physicians for LTC patients. Quality improvement initiatives at the local level may help reduce this discrepancy.

Introduction

L’étude avait principalement pour buts de relever les renseignements fournis dans la documentation en vue de la mutation des patients en soins de longue durée (SLD), et de comparer ces éléments d’information avec les renseignements recherchés par les médecins aux services des urgences (SU) locaux afin qu’ils puissent donner les meilleurs soins possible et prendre des décisions éclairées à leur sujet.

Méthode

Il s’agit d’un examen rétrospectif, d’une durée d’un an, de dossiers d’un échantillon de pensionnaires en SLD, transportés en ambulance au SU d’un hôpital universitaire, de soins tertiaires. Tous les urgentologues travaillant dans l’établissement ont été invités à remplir un questionnaire en ligne sur les renseignements fournis dans la documentation en vue de la mutation des patients en SLD et les renseignements recherchés pour traiter les patients en question.

Résultats

Sur les 200 dossiers examinés, les éléments d’information fournis le plus souvent aux urgentologues sur les patients en SLD étaient les antécédents médicaux (n=184; 92,0 %), le nom du médecin de famille (n=182; 91,0 %), une liste d’allergies connues (n=179; 89,5 %), le motif de mutation au SU (n=155; 77,5 %), les renseignements concernant les personnes à joindre en cas d’urgence (n=152; 76,0 %) et la fiche de médicaments administrés (n=150; 75,0 %). Quant aux médecins, les renseignements recherchés le plus souvent étaient le motif de mutation, les antécédents médicaux, l’état cognitif, les instructions préalables sur le degré de soins à donner et les manœuvres de réanimation ainsi que les renseignements sur les personnes à joindre en cas d’urgence. Ces éléments d’information ont été fournis dans 77,5 % (n=155), 92,0 % (n=184), 24,0 % (n=48), 62,0 % (n=124) et 76,0 % (n=152) des cas, respectivement.

Conclusions

Les résultats de l’étude font ressortir une nette différence entre les renseignements fournis aux urgentologues et les renseignements recherchés par ceux-ci pour les patients en SLD. Des initiatives d’amélioration de la qualité à l’échelle locale pourraient aider à combler les lacunes.

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Copyright

Corresponding author

Correspondence to: Dr. Don Melady, Mount Sinai Hospital, University of Toronto,206-600 University Avenue, Toronto, ON M5G 1X5; Email: don.melady@utoronto.ca

References

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