Open AccessIneffective Communication of Mental Status Information During Care Transfer of Older Adults
Author(s) -
Boockvar Kenneth S.,
Fridman Bella,
Marturano Cinthya
Publication year - 2005
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.00262.x
Subject(s) - medicine , checklist , dementia , mental status examination , mood , mental health , mental illness , minimum data set , socioeconomic status , psychiatry , cognition , family medicine , nursing , disease , nursing homes , psychology , population , environmental health , pathology , cognitive psychology
BACKGROUND: Monitoring and documenting the mental status of older patients transferred between providers or facilities is important because mental status change can be a sign of acute disease and mental status abnormalities necessitate specific approaches to care. OBJECTIVES: To identify patient and illness factors associated with presence of a mental status description in inter‐facility transfer documents and to describe the content and concurrent validity of transfer mental status descriptions when they occur. DESIGN: Retrospective study. PARTICIPANTS: Individuals transferred between 5 long‐term and 2 acute care facilities in an urban setting. MEASUREMENTS: Trained research personnel reviewed hospital and nursing home medical records and inter‐facility transfer documents. Mental status descriptions in transfer documents were coded as abnormal or normal within 5 domains: alertness, communication, orientation/memory, behavior, and mood. Descriptions were compared with mental status items in the nursing home Minimum Data Set and in a transfer communication checklist. RESULTS: In all, 123 nursing home residents experienced 174 hospital admissions. Mental status descriptions were present in 69% of transfer documents. A total of 67% of patients missing a transfer mental status description upon nursing home‐to‐hospital transfer had dementia. Factors associated with presence of a transfer mental status description were urgent transfer, nursing home of origin, and among patients without dementia, greater cognitive impairment. When present, a mean of 1.47 (SD=0.81) cognitive domains were documented in transfer mental status descriptions. Agreement between transfer mental status descriptions and comparison sources was fair to good (κ=.31 to .73). CONCLUSION: Mental status documentation during transfer of older adults between nursing home and hospital did not identify all patients with dementia and did not completely characterize patients' cognitive status.