Associations between characteristics of the patients at municipal acute bed unit admission and further transfer to hospital: a prospective observational study

Synnøve Karin Hernes,Ingrid Hjulstad Johansen,Kurt Arild Krokmyrdal,Sabine Ruths,Valborg Baste,Silje Longva Todnem

doi:10.1186/s12913-020-05823-0

Abstract

BackgroundAs an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level. Patient selection is challenging, and some patients need transfer from MAUs to hospitals. The aim of this study was to examine associations between characteristics of the patient at admission to MAU and further transfer to hospital.MethodsIn a prospective observational study on all admissions to a large MAU, March 2016–August 2017, information was obtained on patient age, gender, comorbidities, drug use, reason for stay and Triage Early Warning Score (TEWS) on admission and at discharge, and length of stay. Comparison between admissions resulting in discharge to hospital, nursing home or own home were performed with chi-square and ANOVA tests. Estimated relative risks (RR) with 95% confidence interval for transfer to hospital versus being retained at primary care level was estimated for age, gender, comorbidity and TEWS in generalized linear models, crude and adjusted.ResultsTwo thousand seven hundred forty-four admissions were included. Mean age of the patients was 69.5 years (SD 21.9), 65.2% were women. In 646 admissions (23.6%), the patients were transferred to hospital. Male gender and TEWS > 2 were associated with transfer to hospital. Most transfers to hospital occurred within 24 h, and these patients had unchanged or increasing TEWS during their stay at MAU. When transferred to hospital 41.5% of the patients had the same reason for stay as on MAU admission, 14.9% had another reason for stay, 25.2% had a medical condition outside the treatment scope of MAU, and 18.4% needed further diagnostic clarification in hospital.ConclusionsLikelihood of transfer to hospital increased with male gender and higher TEWS on admission. Main reasons for transfer to hospital were lack of improvement and identification of clinical conditions that needed hospital care. TEWS > 2 at admission should make physicians alert to the need of close monitoring for lack of improvement.

Highlights

As an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level
MAUs are intended for short-term stays and shall provide inpatient care for patients with clinical conditions that can be treated and cared for at the community care level, and who otherwise would have been admitted to hospital [2]
In most admissions (n = 2567, 93.5%) the patient lived in the municipality the MAU was supposed to serve

Summary

Introduction

As an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level. MAUs are intended for short-term stays and shall provide inpatient care for patients with clinical conditions that can be treated and cared for at the community care level, and who otherwise would have been admitted to hospital [2]. The establishment of MAUs has contributed to reduced numbers of emergency admissions to hospitals, especially for elderly patients [3]. A hospital study in Norway showed reduced mortality among elderly patients treated in specialised geriatric hospital units compared with those treated in general medical wards [11]. Lower care level or less specialised units may lead to delayed diagnostic conclusions and reduced therapeutic quality [10]

Objectives

Methods

Results

Discussion

Conclusion