Ineffective communication of mental status information during care transfer of older adults

J Gen Intern Med. 2005 Dec;20(12):1146-50. doi: 10.1111/j.1525-1497.2005.00262.x.

Abstract

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 (kappa=.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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Cognition Disorders*
  • Communication*
  • Dementia*
  • Homes for the Aged*
  • Humans
  • Nursing Homes*
  • Patient Care
  • Patient Transfer*
  • Retrospective Studies
  • Urban Population