title: Communication gaps in nursing home transfers to the ED: impact on turnaround time, disposition, and diagnostic testing.
abstract: BACKGROUND
  This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing.
  
  
  METHODS
  A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered.
  
  
  RESULTS
  One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0).
  
  
  CONCLUSIONS
  Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing.
authors: St Luke's University Hospital and Health Network, Bethlehem, PA 18015, USA.
authors: Drew
authors: D
authors: Nelson
authors: Danae
authors: D
authors: Washton
authors: Rebecca
authors: R
authors: Jeanmonod
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D055991:Health Records, Personal; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010360:Patient Transfer / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies