title: Management of adverse clinical events by duty physicians in a nursing home.
abstract: OBJECTIVE
  The nature of adverse clinical events (ACE) during duty hours (16:00-08:00 and holidays), as well as the way they are addressed by duty physicians (DP) in a nursing home (NH) are the subject of this study.
  
  
  METHODS
  Data, including medical details concerning ACEs and the resultant referrals to hospital, were collected prospectively during 183 consecutive days in a 90-bed NH.
  
  
  RESULTS
  Ninety-six residents experienced 370 ACEs, representing an average of one for every 44.5 patient days. The highest rate of events was during evening hours (18:00-21:00). The most prevalent ACE was fever (32%). Most cases (53%) were treated by the DPs on site. No intervention was needed in 19% of cases, whereas 28% of ACEs (104 cases) were referred to the Emergency Room (ER) of a general hospital. Sixty-six percent of these were actually admitted. The rate of ER referral of residents was one for every 158 patient days. About 40% of the referred patients had been discharged from hospital the previous week. High fever was the commonest cause for referral: 47%. During the working hours of the study period, the rate of referral by the staff physician was only 1 for every 915 patient days. Only 17% of these had high fever.
  
  
  CONCLUSIONS
  Evening rounds by staff physicians, strengthening of working relations with hospital physicians, as well as fostering intravenous treatment in NHs, are suggested as means for reducing hospital transfers. A standardized method for the reporting of ACEs and referrals to hospitals should be adopted in order to facilitate comparisons between NHs and to evaluate its use as a quality indicator.
authors.affiliation: Shmuel - Harofeh Hospital, Geriatric Medical Center, Israel. shmuelh@netvision.net.il
authors.forename: Arthur
authors.initials: A
authors.lastname: Leibovitz
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Baumoehl
authors.forename: Beni
authors.initials: B
authors.lastname: Habot
authors.forename: Israel
authors.initials: I
authors.lastname: Gil
authors.forename: Emily
authors.initials: E
authors.lastname: Lubart
authors.forename: Vladymir
authors.initials: V
authors.lastname: Kaplun
authors.forename: Rafael
authors.initials: R
authors.lastname: Segal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D005791:Patient Care; D010820:Physicians; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data