Background: Adverse events in the immediate posthospitalization period are a serious threat to patients 65 years and older who are residents of long-term care facilities. Changes during hospitalization – such as fasting for procedures, immobility, change in surroundings, disruption of sleep, and medication adjustments – can lead to adverse events such as falls, pressure ulcers, adverse drug reactions, and health care–acquired infections. However, the frequency and preventability of these adverse events has not been measured.
Dr. Arfaa Ali
Study design: Prospective cohort study.
Setting: Nursing homes in the New England states.
Synopsis: This study sampled 762 hospital discharges for 555 long-term care residents of 32 nursing homes who were discharged from the hospital back to their same long-term care facility and followed for 45 days. A trained nurse reviewed records using a trigger tool developed by the Institute for Healthcare Improvement. Each trigger linked to a possible harm was reviewed by two physicians. Adverse events were categorized into health care–acquired infections and events related to resident care, medications, and procedures. The severity and preventability of each event was assessed.
Of the 555 residents, 65.5% were female and the mean age was 82.2. There were 379 adverse events identified; 52% involved pressure ulcers, skin tears, and falls with injury, which were deemed preventable. Healthcare-acquired infections totaled 28.5% and adverse drug events were 16.5%. Close to half of the events were serious, life threatening, or fatal. The study was limited by subjectivity in classifying the adverse events.
Hospitalists should ensure proper coordination and handoff when transitioning patients back to their nursing home.
Bottom line: Adverse events occur in 4 of 10 discharges from the hospital to long-term care facilities, and most events are preventable.
Citation: Kapoor A et al. Adverse events in long-term care residents transitioning from hospital back to nursing home. JAMA Intern Med. 2019 Jul 22;179(9):1254-61.
Dr. Ali is assistant professor of internal medicine and section chief of hospital medicine at St. Louis University School of Medicine.