Nursing Home to Emergency Care Transition Form Has Limited Uptake But Improves Documentation

Abstract

Critical information gaps exist in nursing home–to–emergency department (NH-ED) transfer documentation. Standardization of forms may address these gaps. In a single state, a Continuity of Care Acute Care Transfer (CoC) Form was standardized and mandated to be used for all NH-ED transfers. The objective of this study was to evaluate adoption and effectiveness of the standardized CoC form. We used a random cross-sectional sample of 2019–2022 electronic health record encounter data to determine NH-ED documentation completeness after standardized CoC form implementation. Using patient characteristic adjusted linear and logistic regressions, we examined if CoC form standardization was associated with the number of key elements present on NH-ED transfer documentation and hospital admission, respectively. We then compared documentation completeness (out of 15 key data elements) to previously published pre-implementation data (2015–2016, n = 474). Of the 203 NH-ED transfer visits after CoC standardization (2019–2022), mean patient age was 81.8 years and 41.4% had dementia. Any NH-ED transfer form was present for 80.8% (n = 164) of encounters and 28.6% (n = 58) used the standardized CoC form. In comparison with the 2015–2016 data, there was an increase in documentation for functional baseline (20% to 30%), cognitive baseline (25% to 37%), and reason for transfer (25% to 82%). Post implementation, the use of the standardized CoC form was (1) associated with 2.55 (95% CI, 1.66–3.44) more key data elements documented and (2) not associated with a decreased odds of admission [odds ratio (OR), 1.06; 95% CI, 0.54–2.05] after controlling for confounders. Implementation of a statewide standardized CoC form for NH-ED transfers improved documentation of key elements, yet significant information gaps remain. Implementation evaluation is needed to identify how to achieve greater uptake of the form and improve the quality of information exchange between NHs and EDs.