During the course of a single hospitalization, patients are often transferred to multiple units, which can compromise efficiency, continuity, and quality of care.

A review of the hospital records of 7,851 patients 60 years old and older found that only 31% received care on only one unit, while 34% were treated on three or more units. Most of the patients in the sample were white, female, and married. The most common admitting diagnoses were circulatory problems and cancer. The severity of illness on admission was rated as major or severe in 49% of cases. At discharge, two-thirds of patients were able to return home.

On average, patients cared for on one unit received education concerning their condition nearly once a day and interventions related to discharge planning 0.73 times a day. Among patients treated on five or more units, the frequency of patient education was halved, and the rate for discharge planning dropped to 0.65 times a day. As the number of units per hospitalization increased, the risk of acquiring a nosocomial infection or experiencing a fall or medication error also increased-and the chances of being discharged home decreased. In addition, transferring to multiple units increased both the length of stay and total hospital costs-hospitalizations on one unit had a mean cost of $8,215, which increased to $10,576 for two units, $20,711 for three to four units, and $44,596 for five or more units.

This study suggests that minimizing the number of transfers from unit to unit during a single hospitalization is associated with more consistent nursing care, fewer adverse incidents, shorter hospital stays, and lower overall costs.