Journal of the American Medical Directors Association
Original StudiesImpact of Physician Telephone Management of Nursing Home Residents Before the Initial Assessment: A Pilot Study
Section snippets
Methods
This study was a retrospective chart review of closed medical records from two community nursing homes for 111 consecutive discharges in 1999. From each record, data pertinent to the original nursing home admission were abstracted onto a standardized form. These data included the resident's age, race and sex; the day, date, and time of admission; the number of medical diagnoses on the problem list; the number of medications initially ordered; whether or not advance directives were noted in the
Results
Data concerning resident demographics, the types of referring facilities, and days and times of admission to the nursing homes are shown in Table 1. Residents were admitted between January 1997 and October 1999. The mean age of residents was 73 years; 47% were women, 68% were white, most (91%) had accompanying discharge medication lists from a recent hospitalization, an average of 6.9 medications were prescribed at the time of admission, and an attending physician was contacted for approval of
Discussion
Despite our hypothesis that physicians typically do not make changes when confirming admission orders by telephone for nursing home residents, we found that physicians made changes in medications and/or requested testing more than half of the time. In an attempt to assess the impact of this activity, we evaluated the rate of death or readmission to the hospital within 14 days of the admission to the nursing home. When the physician made changes in the medications listed in the preadmission
Acknowledgments
The authors thank Laura Gibson for her valuable assistance in the preparation of this manuscript.
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