title: Where do we go from here? A small scale observation of transfer results from chronic to skilled ventilator facilities.
abstract: OBJECTIVE
  Skilled nursing facility ventilator units (SNF) are a recent attempt to reduce the costs of an increasing number of patients who are in acute intensive care units and are not able to be liberated from ventilators. Transfers of such patients from long-term care chronic vent units (LTCVs) to SNFs in Maryland began in 2006. The safety of these transfers needs to be assessed.
  
  
  METHODS
  We retrospectively followed up all patients designated as eligible by their insurance for transfer from our LTCV units to SNF from July 1, 2008 through June 30, 2010 looking only at survival. Those patients who refused transfer and appealed and remained in our LTCV were compared to those who were transferred to SNF ventilator units. The analysis was by Kaplan-Meier statistics.
  
  
  RESULTS
  There was an increased mortality (P=.025) of those transferred to SNF ventilator facilities as compared to those remaining in the LTCV.
  
  
  CONCLUSIONS
  We recognize that bias may occur in patients choosing to remain in our LTCV compared to those accepting transfers, the magnitude of the difference in mortality indicates the need for more comprehensive well designed analysis investigating the outcome of all transfers occurring to and from LTCVs.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: wgreeno2@jhmi.edu.
authors.forename: William B
authors.initials: WB
authors.lastname: Greenough
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maaz
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Finucane
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Panagis
authors.initials: P
authors.lastname: Galiatsatos
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Bellantoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D003365:Costs and Cost Analysis; D016638:Critical Illness / Q000191:economics / Q000401:mortality; D003625:Data Collection; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010360:Patient Transfer; D012121:Respiration, Artificial / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012866:Skilled Nursing Facilities / Q000191:economics / Q000458:organization & administration*; D012122:Ventilators, Mechanical / Q000191:economics*
keywords: Chronic; Death; Geriatrics; Mortality; Skilled; Ventilator