Should change in mental status and fever result in rapid hospital transfer?
Many of these hospitalizations may not be warranted. For example, if a patient has a fever or a change in level of consciousness, nurses generally have 30 minutes or more to carry out a careful evaluation before deciding whether an emergency transfer is necessary. Transfers should be limited to situations of genuine clinical necessity. Hospitalization of long-term care patients should be avoided for many reasons. Transfer to the ER or hospital is costly; is disruptive for patients; and can expose patients to many risks, including delirium, undernutrition, serious infections, skin breakdown, and adverse drug reactions. By contrast, care in the long-term care facility occurs in a familiar environment and costs much less than hospitalization. Evidence suggests that the residents of long-term care facilities who are most likely to be hospitalized are also the least likely to obtain a beneficial outcome from a hospitalization. In severely impaired patients, mortality rates are similar with
