title: Referrals from nursing home to hospital: reasons, appropriateness and costs.
abstract: BACKGROUND
  Nursing home residents represent a frail and multimorbid group of patients. The rationality of the hospitalisation of nursing home patients has therefore been questioned.
  
  
  OBJECTIVE
  To investigate hospital referrals of nursing home patients in the municipality of Stavanger, Norway and identify the number of inappropriate referrals and costs.
  
  
  METHODS
  The number of referrals was retrospectively identified by the emergency dispatch centre in the 18 municipalities of South Rogaland in 2011. For the municipality of Stavanger, referring instance, reason for referral, purpose of referral, the existence of an advance care plan, and appropriateness were assessed. Total costs and costs for inappropriate referrals were estimated.
  
  
  RESULTS
  In Stavanger there were 0.38 hospital referrals per nursing home bed per year as compared to 0.60 in the surrounding municipalities. Of 359 referrals, 78.6% resulted in an in-hospital stay, in-hospital mortality rate was 7.8%, and 7% were assessed as being inappropriate. The costs per referral were estimated to be €6198.
  
  
  CONCLUSIONS
  Stavanger had a lower referral rate than the surrounding municipalities. The results also show that the in-hospital mortality rate and the share of inappropriate referrals were low compared to other studies in the field. Further research is needed in order to evaluate which interventions are effective in improving medical care at nursing homes and thus reduce referral rates.
authors.affiliation: Centre for Age-related Medicine, Stavanger University Hospital, Norway. c.vossius@hotmail.com
authors.forename: Corinna Elisabeth
authors.initials: CE
authors.lastname: Vossius
authors.forename: Arnt Egil
authors.initials: AE
authors.lastname: Ydstebø
authors.forename: Ingelin
authors.initials: I
authors.lastname: Testad
authors.forename: Hilde
authors.initials: H
authors.lastname: Lurås
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006707:Homes for the Aged; D006761:Hospitals; D006801:Humans; D008297:Male; D009664:Norway; D009735:Nursing Homes; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Appropriateness of hospital admissions; costs; hospital referrals; nursing home; saving potentials