AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits
Electronic Reports
Table 4. Sample ED Treat and Release Report
Facility Name:
Month:
Average Daily Census | 30 | Total Transfers (Obs, ED) | 11 |
Resident Days (including bed holds) | 300 | Total Residents (Obs, ED) | 10 |
ED Visit | ||
---|---|---|
Resident | ED Visit Date | ED Discharge Diagnosis |
Resident A | 11/11/2013 | Angina |
Resident B | 11/20/2013 | UTI |
Resident C | 11/15/2013 | Anemia |
Resident D | 11/13/2013 | COPD |
Resident G | 11/2/2013 | Gastroenteritis |
Resident G | 11/11/2013 | Fracture |
Resident J | 11/20/2013 | G tube replacement |
Resident P | 11/10/2013 | Dehydration |
Resident R | 11/1/2013 | Pneumonia |
Resident T | 11/30/2013 | Asthma |
Resident Y | 11/30/2013 | Laceration |
Total reasons | 21 | |
% Total reasons |
Table 4 (continued)
Reason for Transfer | |||||||
---|---|---|---|---|---|---|---|
Resident | Cardiac/ Circulatory Symptoms |
Respiratory Symptoms |
Mental/ Psychiatric/ Neurological Symptoms |
Gastrointestinal/ Genitourinary Symptoms |
Endocrine/ Metabolic/ Nutrition Issues |
Wound or Skin Issues |
|
Resident A | X | ||||||
Resident B | X | ||||||
Resident C | |||||||
Resident D | X | ||||||
Resident G | X | X | |||||
Resident G | |||||||
Resident J | X | ||||||
Resident P | X | X | |||||
Resident R | X | ||||||
Resident T | X | ||||||
Resident Y | |||||||
Total reasons | 1 | 3 | 1 | 3 | 2 | 0 | |
% Total reasons | 5 | 14 | 5 | 14 | 10 | 0 |
Table 4 (continued)
Reason for Transfer | |||||||
---|---|---|---|---|---|---|---|
Resident | Injury: Fall Related | Injury: Not Fall Related | Musculoskeletal Symptoms | Abnormal Labs or Anemia | Fever/Possible Infection | Malaise/Fatigue | Possible Surgical Complication |
Resident A | |||||||
Resident B | |||||||
Resident C | X | X | |||||
Resident D | X | ||||||
Resident G | X | ||||||
Resident G | X | ||||||
Resident J | |||||||
Resident P | X | X | |||||
Resident R | X | X | |||||
Resident T | X | ||||||
Resident Y | X | ||||||
Total reasons | 1 | 1 | 0 | 4 | 3 | 2 | 0 |
% Total reasons | 5 | 5 | 0 | 19 | 14 | 10 | 0 |
Table 4 (continued)
Reason for Transfer: Treatment Unavailable at Facility | Authorized by: | ||||||||
---|---|---|---|---|---|---|---|---|---|
Resident | Diagnostics: Radiology, Imaging | IV Access: PICC, Central, Periph; Meds or Fluids | Transfusion | Catheter Insertion/ Reinsertion |
Primary Care Physician | Covering Provider | Medical Director | Medicare Managed Care Organization | Outside Clinic or Service |
Resident A | X | ||||||||
Resident B | X | ||||||||
Resident C | X | X | |||||||
Resident D | X | ||||||||
Resident G | X | ||||||||
Resident G | X | ||||||||
Resident J | X | X | |||||||
Resident P | X | ||||||||
Resident R | X | X | |||||||
Resident T | X | ||||||||
Resident Y | X | ||||||||
Total reasons | |||||||||
% Total reasons |
Table 4 (continued)
Nursing Home Treatments 24 Hours Prior to Transfer | ||||||||
---|---|---|---|---|---|---|---|---|
Resident | Labwork Obtained | X Rays Obtained | IV Fluids/ Subcutaneous Fluids |
Oxygen | Respiratory Treatment | Respiratory Suctioning | Medications: IV, Intramuscular, or SQ | Medications: Oral |
Resident A | X | X | ||||||
Resident B | X | |||||||
Resident C | X | |||||||
Resident D | X | X | ||||||
Resident G | X | X | ||||||
Resident G | ||||||||
Resident J | ||||||||
Resident P | X | X | ||||||
Resident R | X | X | X | X | X | |||
Resident T | X | X | ||||||
Resident Y | ||||||||
Total reasons | ||||||||
% Total reasons |
Table 4 (continued)
Seen by (Within 24 Hours Prior to Transfer): | Prior ED Visit | Prior Hospital Discharge | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Resident | Primary Care Physician | Covering Provider | Consulting Physician | Nurse Practitioner or Physician's Assistant | Respiratory Therapist | Other | 0-3 Days | 4-30 Days | 0-7 Days | 8-30 Days |
Resident A | X | |||||||||
Resident B | X | 1 | ||||||||
Resident C | X | 1 | ||||||||
Resident D | 1 | |||||||||
Resident G | X | |||||||||
Resident G | 1 | |||||||||
Resident J | 1 | |||||||||
Resident P | X | 3 | 1 | |||||||
Resident R | X | |||||||||
Resident T | X | 1 | 1 | |||||||
Resident Y | ||||||||||
Total reasons | ||||||||||
% Total reasons |