Which Signs and Symptoms Warrant Involvement of Medical Staff? The Definition and Identification of Status-change Events in the Nursing Home

Abstract

In this article, the authors clarify the concept of status-change events (a significant clinical change that calls for medical follow-up by a physician) by providing preliminary descriptions of these events, and attempting to differentiate them from incidents that did not qualify as status-change events. Participants were residents from a large, nonprofit nursing home. Data were collected about the source of information, the nature of the incident, whether it qualified as a status-change event, and the reason (if any) for disqualification. The most common incidents involved in status-change events were troubled breathing, aspiration, fracture, and hypotension. The most common incidents that did not qualify as status-change events were continuing pneumonia, bruises, lacerations, disorientation, and blood pressure abnormalities. A wide range of physical ailments characterized both status-change events and incidents that did not qualify as status-change events. The main reason an incident did not qualify was because it did not warrant contacting the physician. The nature of the incident is insufficient in itself to determine whether the incident qualifies as a status-change event. The process for identifying and analyzing status-change events in the nursing home requires several steps and much persistence.

Key Words:

• acute illness
• cognitive impairment
• dementia
• medical decision making

Additional information

Notes on contributors

Debra Horton

Dr Cohen-Mansfield and Dr Lipson are with the Research Institute on Aging, Hebrew Home of Greater Washington, at George Washington University Medical Center. Ms Horton is with the Hebrew Home of Greater Washington.