Relationship of long-term and acute-care facilities. The problem of patient transfer and continuity of care

J Am Geriatr Soc. 1985 Dec;33(12):819-26. doi: 10.1111/j.1532-5415.1985.tb05433.x.


Approximately 17% of patients residing in an extended-care facility--which provides close physician-patient contact and strong affiliation with an acute-care hospital, although does not have the capacity for intravenous therapy--required admission to an acute-care hospital during a one-year period. The most common medical problem necessitating transfer to the acute-care hospital was an infectious process. Most infections were correctly diagnosed in the extended-care facility, but due to the inability to administer intravenous therapy, transfer was thought mandatory. The acute-care hospital stay was short, which is thought to reflect partially the close affiliation between the extended-care facility and acute-care hospital. Complications occurred while patients were in the acute-care hospital with 30% demonstrating new pressure sores upon their return to the extended-care facility. Repeated acute-care hospital admissions were not uncommon, usually occurring within a short period after the patient's return to the extended-care facility, and commonly related to the same medical disorder that caused the initial admission. Prognosis was poor in patients who required admission to the acute-care hospital and mortality rate increased to approximately 50% in patients requiring multiple admissions. It is concluded that an extended-care facility that provides a high level of physician-patient contact and a close affiliation with an acute-care hospital is advantageous in providing efficient and continual care for the elderly. Provisions for the administration of intravenous therapy might even increase the efficiency of such a facility.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Continuity of Patient Care*
  • Critical Care / organization & administration*
  • Female
  • Fluid Therapy
  • Geriatrics
  • Humans
  • Infections / diagnosis
  • Infections / therapy
  • Injections, Intravenous
  • Length of Stay
  • Male
  • Middle Aged
  • Organizational Affiliation
  • Patient Readmission
  • Physician-Patient Relations
  • Pressure Ulcer / etiology
  • Primary Health Care*
  • Referral and Consultation*
  • Skilled Nursing Facilities / organization & administration*