Table 1 Summary of Resident Transfer Data
ID | Age (in yrs) Race/Sex # Transfers (%) Denotes percent potentially avoidable | Signs/symptoms and/or diagnoses at transfer (#) Denotes number of times this condition/diagnosis was present at transfer | Clinical needs | Medical/ Mental health history | Resident/Family Request to transfer | Transfer Outcome/ |
|---|---|---|---|---|---|---|
#1 | 61Â years White female 8 transfers (86%) | Fall with head injury (i.e., laceration, bleeding) (5), altered mental status (2), unresponsiveness (2), fall with other injury (1), seizure (1), wounds (1) | None reported | Seizures Chronic pain Depression Anxiety | None reported | Admit (1) ED (7) |
#2 | 53Â years Black male 9 transfers (33%) | Elevated temperature (6), Sepsis (5), UTI (2), wound infection (2), fall (1), hematuria (1), acute renal failure (1), colostomy (planned) (1) | Wound care Colostomy Central line Foley catheter | Diabetes Multiple Sclerosis Depression | None reported | Admit (8) Missing (1) |
#3 | 67Â years White female 9 transfers (44%) | Shortness of breath (4), GI bleeding (2), bleeding, other (2), emergent dialysis (1), low pulse oximetry (1) | Dialysis Wound care | ESRD COPD | Resident (2) | Admit (9) |
#4 | 49Â years White female 10 transfers (40%) | Shortness of breath (3), wound infections (3), altered mental status (2), COPD (1), sepsis (1), respiratory failure (1), hypoglycemia (1), unresponsive (1), low pulse oximetry (3), elevated temperature (1) | Dialysis Wound care Supplemental Oxygen | ESRD COPD CHF Seizure Depression Anxiety | None reported | Admit (9) Missing (1) |
#5 | 58Â years Black male 10 transfers (30%) | Hyperglycemia (4), hypoglycemia (2), emergent dialysis (1), dialysis shunt malfunction (1), shortness of breath (1), unresponsiveness (1), low hemoglobin (1), altered mental status (1), pneumonia (1), UTI (1) | Dialysis | ESRD DKA | Resident (1) | Admit (8) ED (1) Obs (1) |
#6 | 64 years Black female 10 transfers (70%) | Fall w/ injury to head (9), fall w/ other injury (1), UTI (1) | None reported | COPD Parkinson’s Alcoholism | None reported | Admit (3) ED (7) |
#7 | 62Â years Black male 11 transfers (27%) | GI bleeding (7), UTI (5), pneumonia (2), sepsis (2), hematuria (1), seizure (1), G-tube malfunction (1), shortness of breath (1), elevated temperature (1), low pulse oximetry (2) | Tracheostomy Foley catheter G-tube Oxygen | CVA Seizures Anxiety | None reported | Admit (9) ED (2) |
#8 | 64Â years White female 11 transfers (55%) | UTI (7), kidney stone removal, (4), sepsis (2), elevated temperature (1) | None reported | Diabetes Chronic pain Depression | None reported | Admit (10) Obs (1) |
#9 | 44Â years Black male 14 transfers (50%) | Sepsis (7), UTI (8), hematuria (6), pneumonia (3), respiratory failure (3), GI bleeding (1), shortness of breath (3), low pulse oximetry (3), elevated temperature (1) | Tracheostomy Foley catheter G-tube Oxygen | Anoxic brain injury Anxiety | Family (10) | Admit (12) ED (1) Obs (1) |
#10 | 45Â years Black male 14 transfers (86%) | Seizures (10), UTI (5), pneumonia (2) hematuria (1), shortness of breath (2); elevated temperature (1), low pulse oximetry (1) | Suprapubic catheter G-tube | Seizures Multiple Sclerosis Schizophrenia | Family (11) | Admit (9) ED (3) Missing (2) |
#11 | 38Â years White female 15 transfers (53%) | Shortness of breath (9), pneumonia (4), COPD (3), acute psychiatric care (2), tracheostomy tube replaced (2); elevated temperature (1) | Tracheostomy Oxygen | COPD Depression Anxiety Bipolar disorder | Resident (7) | Admit (12) ED (3) |