1
|
Lemoyne S, Van Bastelaere J, Nackaerts S, Verdonck P, Monsieurs K, Schnaubelt S. Emergency physicians' and nurses' perception on the adequacy of emergency calls for nursing home residents: a non-interventional prospective study. Front Med (Lausanne) 2024; 11:1396858. [PMID: 38962739 PMCID: PMC11220277 DOI: 10.3389/fmed.2024.1396858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction A considerable percentage of daily emergency calls are for nursing home residents. With the ageing of the overall European population, an increase in emergency calls and interventions in nursing homes (NH) is to be expected. A proportion of these interventions and hospital transfers may be preventable and could be considered as inappropriate by prehospital emergency medical personnel. The study aimed to understand Belgian emergency physicians' and emergency nurses' perspectives on emergency calls and interventions in NHs and investigate factors contributing to their perception of inappropriateness. Methods An exploratory non-interventional prospective study was conducted in Belgium among emergency physicians and emergency nurses, currently working in prehospital emergency medicine. Electronic questionnaires were sent out in September, October and November 2023. Descriptive statistics were used to analyze the overall results, as well as to compare the answers between emergency physicians and emergency nurses about certain topics. Results A total of 114 emergency physicians and 78 nurses responded to the survey. The mean age was 38 years with a mean working experience of 10 years in prehospital healthcare. Nursing home staff were perceived as understaffed and lacking in competence, with an impact on patient care especially during nights and weekends. General practitioners were perceived as insufficiently involved in the patient's care, as well as often unavailable in times of need, leading to activation of Emergency Medical Services (EMS) and transfers of nursing home residents to the Emergency Department (ED). Advance directives were almost never available at EMS interventions and transfers were often not in accordance with the patient's wishes. Palliative care and pain treatment were perceived as insufficient. Emergency physicians and nurses felt mostly disappointed and frustrated. Additionally, differences in perception were noted between emergency physicians and nurses regarding certain topics. Emergency nurses were more convinced that the nursing home physician should be available 24/7 and that transfers could be avoided if nursing home staff had more authority regarding medical interventions. Emergency nurses were also more under the impression that pain management was inadequate, and emergency physicians were more afraid of the medical implications of doing too little during interventions than emergency nurses. Suggestions to reduce the number of EMS interventions were more general practitioner involvement (82%), better nursing home staff education/competences (77%), more nursing home staff (67%), mobile palliative care support teams (65%) and mobile geriatric nursing intervention teams (52%). Discussion and conclusion EMS interventions in nursing homes were almost never seen as necessary or indicated by emergency physicians and nurses, with the appropriate EMS level almost never being activated. The following key issues were found: shortages in numbers and competence of nursing home staff, insufficient primary care due to the unavailability of the general practitioner as well as a lack of involvement in patient care, and an absence of readily available advance directives. General practitioners should be more involved in the decision to call the Emergency Medical Services (EMS) and to transfer nursing home residents to the Emergency Department. Healthcare workers should strive for vigilance regarding the patients' wishes. The emotional burden of deciding on an avoidable hospital admission of nursing home residents, perhaps out of fear for medico-legal consequences if doing too little, leaves the emergency physicians and nurses frustrated and disappointed. Improvements in nursing home staffing, more acute and chronic general practitioner consultations, and mobile geriatric and palliative care support teams are potential solutions. Further research should focus on the structural improvement of the above-mentioned shortcomings.
Collapse
Affiliation(s)
- Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Joanne Van Bastelaere
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Department of Public Health and Primary Care, Catholic University of Leuven, Leuven, Belgium
| | - Sofie Nackaerts
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Philip Verdonck
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Koenraad Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- Emergency Medical Service Vienna, Vienna, Austria
| |
Collapse
|
2
|
Pu D, Cameron P, Chapman W, Greenstock L, Sanci L, Callisaya ML, Haines T. Virtual emergency care in Victoria: Stakeholder perspectives of strengths, weaknesses, and barriers and facilitators of service scale-up. Australas Emerg Care 2024; 27:102-108. [PMID: 37852805 DOI: 10.1016/j.auec.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Virtual emergency services have been proposed as an alternative service model to conventional in-person emergency department attendance. METHODS Twenty participants were interviewed: 10 emergency medicine physicians, 4 health care consumers, and 6 other health care professionals. Conventional content analysis was performed on the interview transcriptions to identify perceived strengths and weaknesses of the VED, and barriers and facilitators to scaling-up the VED. RESULTS VEDs are perceived as a convenient approach to provide and receive emergency care while ensuring safety and quality of care, however some patients may still need to attend the ED in person for physical assessments. There is currently a lack of evidence, guidelines, and resources to support their implementation. Most of the potential and existing barriers and facilitators for scaling-up the VED were related to their effectiveness, reach and adoption. Broader public health contextual factors were viewed as barriers, while potential actions to address resources and costs could be facilitators. CONCLUSIONS VEDs were viewed as a convenient service model to provide care, can not replace all in-person visits. Current policies and guidelines are insufficient for wider implementation. Most of the barriers and facilitators for its scaling-up were related to VED effectiveness and delivery.
Collapse
Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Emergency and Trauma Centre, The Alfred Hospital, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Australia; Melbourne Academic Centre for Health, Australia
| | | | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; The ALIVE National Centre for Mental Health Research Translation, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia
| |
Collapse
|
3
|
Nummedal MA, King SE, Uleberg O, Pedersen SA, Bjørnsen LP. Patients' pathways to the emergency department: a scoping review. Int J Emerg Med 2024; 17:61. [PMID: 38698343 PMCID: PMC11067175 DOI: 10.1186/s12245-024-00638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a common healthcare issue with multiple causes. One important knowledge area is understanding where patients arrived from and what care they received prior to ED admission. This information could be used to inform strategies to provide care for low acuity patients outside of the hospital and reduce unnecessary ED admissions. The aim of this scoping review was to provide a comprehensive overview of global published research examining the acute care trajectory of all ED patients. METHODS The scoping review was performed according to the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive literature search was performed to identify studies describing where patients arrived from and/or whose pathway of care was before an ED visit. The search was conducted in MEDLINE, Embase, and the Cochrane Library from inception through December 5th, 2022. Two reviewers independently screened the records. RESULTS Out of the 6,465 records screened, 14 studies from Australia, Canada, Haiti, Norway, Sweden, Switzerland, Belgium, Indonesia, and the UK met the inclusion criteria. Four studies reported on where patients physically arrived from, ten reported how patients were transported, six reported who referred them, and six reported whether medical care or advice was sought prior to visiting an ED. CONCLUSION This scoping review revealed a lack of studies describing patients' pathways to the ED. However, studies from some countries indicate that a relatively large proportion of patients first seek care or guidance from a primary care physician (PCP) before visiting an ED. However, further research and published data are needed. To improve the situation, we recommend the development and implementation of a template for the uniform reporting of factors outside the ED, including where the patient journey began, which healthcare facilities they visited, who referred them to the ED, and how they arrived.
Collapse
Affiliation(s)
- Målfrid Asheim Nummedal
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sarah Elizabeth King
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital - Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sindre Andre Pedersen
- Library Section for Research Support, Data and Analysis, The Medicine and Health Library, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Petter Bjørnsen
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital - Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
4
|
Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessière S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc 2024; 25:572-579.e1. [PMID: 38159914 DOI: 10.1016/j.jamda.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.
Collapse
Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; Regional Health Agency of Occitanie, Toulouse, France.
| | | | - Emilie Berard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; UMR 1295 CERPOP, INSERM-Université de Toulouse III, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France
| |
Collapse
|
5
|
Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
Collapse
Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| |
Collapse
|
6
|
Hirooka K, Fukahori H, Ninomiya A, Fukui S, Takahashi K, Anzai T, Ishibashi T. Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities. Arch Gerontol Geriatr 2024; 117:105183. [PMID: 37690255 DOI: 10.1016/j.archger.2023.105183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE With the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. METHOD Using the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. RESULTS Of the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77-1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28-0.89) among the LTCF residents. CONCLUSIONS Although ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.
Collapse
Affiliation(s)
- Kayo Hirooka
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; The Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
| | - Ayako Ninomiya
- The Dia Foundation for Research on Ageing Societies, Tokyo, Japan; Division of Fundamental Nursing, Josai International University, Chiba, Japan
| | - Sakiko Fukui
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; The Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | |
Collapse
|
7
|
Gagliano M, Bula CJ, Seematter-Bagnoud L, Michalski-Monnerat C, Nguyen S, Carron PN, Mabire C. Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization. BMC Geriatr 2023; 23:642. [PMID: 37817072 PMCID: PMC10565963 DOI: 10.1186/s12877-023-04321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.
Collapse
Affiliation(s)
- Mariangela Gagliano
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland.
- Department of Geriatrics, Rehabilitation and Palliative Care, Neuchâtel Hospital Network, Rue du Chasseral 20, La Chaux-de-Fonds, CH-2300, Switzerland.
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Carole Michalski-Monnerat
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, Neuchâtel, CH-2000, Switzerland
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Sylvain Nguyen
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Cédric Mabire
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| |
Collapse
|
8
|
Hoffmann F, Habbinga K. [Emergency department visits by nursing home residents: analysis of routine data from an urban hospital]. Med Klin Intensivmed Notfmed 2023; 118:549-555. [PMID: 36069998 PMCID: PMC10564807 DOI: 10.1007/s00063-022-00952-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of emergency department (ED) visits in Germany continues to increase, especially by older people and persons receiving care. OBJECTIVES We aimed to characterize ED visits by nursing home residents (NHR) in Germany. MATERIALS AND METHODS We analyzed routine data of a hospital without trauma surgery (Pius-Hospital Oldenburg). All ED visits by NHR in the period 06/2014-05/2017 were selected from the hospital information system. RESULTS Of 47,270 ED visits, 1676 (3.6%) were NHR (mean age: 78.8 years; 62.9% women; 40.3% were referred). Of them, 20.1% were on weekends and 80.6% occurred between 8 am-8 pm. A total of 84.2% visits led to hospitalization; the length of stay was 1 day for 21.1% and 2-3 days for another 14.6%. With longer length of stay, the proportion of admissions by referring physicians increased. Of those admitted, 10.3% died during hospitalization (28.2% on the day of admission; 47.9% within the first 3 days). People who died were older, their visits were more frequently on weekends, and they were less often referred. CONCLUSION Our study reveals problems in several areas. Improved interprofessional cooperation with general practitioners and strengthened palliative structures should be implemented in nursing homes. Furthermore, there is a need for establishing processes in EDs to realize continued outpatient care for these patients.
Collapse
Affiliation(s)
- Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Kirsten Habbinga
- Pius-Hospital, Medizinischer Campus der Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| |
Collapse
|
9
|
Lemoyne SEE, Van Bogaert P, Calle P, Wouters K, Deblick D, Herbots H, Monsieurs K. Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care? Acta Clin Belg 2023; 78:3-10. [PMID: 35234573 DOI: 10.1080/17843286.2022.2042644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The decision to transfer a nursing home (NH) resident to an emergency department (ED) is multifactorial and challenging but many of the emergency physician-staffed emergency medical service (EP-EMS) interventions and ED transfers are probably inappropriate. METHODS We conducted a retrospective, cross-sectional study in three EP-EMSs in Belgium over a period of three years. We registered indicators that are potentially associated with inappropriate transfers: patient characteristics, availability of written do not resuscitate (DNR) orders or treatment restrictions, involvement of a general practitioner (GP) and availability of transfer notes. We also explored the association between age, the Charlson Comordity Index (CCI), polypharmacy, dementia, and the availability of DNR documents. RESULTS We registered 308 EP-EMS interventions in NH residents. In 98% the caller was a health-care professional. In 75% there was no GP present and 40% had no transfer note. Thirty-two percentage of the patients had dementia, 45% had more than two comorbidities and 68% took five medications or more. In 6% cardiopulmonary resuscitation was performed. DNR orders were available in 25%. Eighty-eight percentage of the NH residents were transferred to the ED. Forty-four percent had a CCI >5. In patients of ≥90 years, with a CCI >5, with dementia and with polypharmacy, DNR orders were not available in 81%, 67%%,and 69%, respectively. CONCLUSIONS Improved EMS dispatch centre-NH caller interaction, more involvement of GP's, higher availability of DNR orders and better communication between GPs/NHs and EP-EMS could prevent inappropriate interventions, futile prehospital aactions,and ED transfers.
Collapse
Affiliation(s)
- Sabine E E Lemoyne
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, University of Antwerp, Edegem, Belgium
| | - Paul Calle
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Dennis Deblick
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hanne Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kg Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
10
|
Vuilleumier S, Spichiger T, Dénéréaz S, Fiorentino A. Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines. BMC Emerg Med 2023; 23:4. [PMID: 36635638 PMCID: PMC9836922 DOI: 10.1186/s12873-023-00772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients' sociodemographic characteristics (age, location, gender) prior to and during the outbreak. METHOD This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student's t test, and Mann‒Whitney U test. RESULTS The pandemic has had two major impacts on the population's emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. CONCLUSION Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.
Collapse
Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| | - Thierry Spichiger
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Sandrine Dénéréaz
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| |
Collapse
|
11
|
Choi YR, Chang SO. Exploring interprofessional communication during nursing home emergencies using the SBAR framework. J Interprof Care 2023; 37:83-90. [PMID: 34757886 DOI: 10.1080/13561820.2021.1985985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.
Collapse
Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| |
Collapse
|
12
|
Zúñiga F, Gaertner K, Weber-Schuh SK, Löw B, Simon M, Müller M. Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review. BMC Geriatr 2022; 22:659. [PMID: 35948872 PMCID: PMC9367060 DOI: 10.1186/s12877-022-03308-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Emergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital. Methods This is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (≥ 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits—measured as ambulatory-care sensitive conditions (ACSCs)—were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis. Results Six percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p≤0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p≤0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p≤0.001) and laboratory resource use (334 tax points vs. 214, p≤0.001) were higher for potentially-avoidable ED visits. Conclusions We revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings’ public health implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03308-9.
Collapse
Affiliation(s)
- Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Katharina Gaertner
- Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | - Sabine K Weber-Schuh
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,GP practice, Praxis Weissenbühl, Bern, Switzerland
| | - Barbara Löw
- Department of Practice Development in Nursing, Solothurner Spitaler AG, Solothurn, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
13
|
Guerbaai RA, Kressig RW, Zeller A, Tröger M, Nickel CH, Benkert B, Wellens NI, Osińska M, Simon M, Zúñiga F. Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers. J Am Med Dir Assoc 2022; 23:1304-1310.e2. [DOI: 10.1016/j.jamda.2022.01.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
|
14
|
Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study. Aging Clin Exp Res 2021; 33:2231-2241. [PMID: 33258074 PMCID: PMC8302553 DOI: 10.1007/s40520-020-01751-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 01/20/2023]
Abstract
Background Emergency department visits and hospital admissions are common among nursing home residents (NHRs) and seem to be higher in Germany than in other countries. Yet, research on characteristics of transfers and involved persons in the transfer decision is scarce. Aims The aim of this study was to analyze the characteristics of hospital transfers from nursing homes (NHs) focused on contacts to physicians, family members and legal guardians prior to a transfer. Methods We conducted a multi-center study in 14 NHs in the regions Bremen and Lower Saxony (Northwestern Germany) between March 2018 and July 2019. Hospital transfers were documented for 12 months by nursing staff using a standardized questionnaire. Data were derived from care records and perspectives of nursing staff and were analyzed descriptively. Results Among 802 included NHRs, n = 535 unplanned hospital transfers occurred of which 63.1% resulted in an admission. Main reasons were deterioration of health status (e.g. fever, infections, dyspnea and exsiccosis) (35.1%) and falls/accidents/injuries (33.5%). Within 48 h prior to transfer, contact to at least one general practitioner (GP)/specialist/out-of-hour-care physician was 46.2% and varied between the NHs (range: 32.3–83.3%). GPs were involved in only 34.8% of transfer decisions. Relatives and legal guardians were more often informed about transfer (62.3% and 66.8%) than involved in the decision (21.8% and 15.1%). Discussion Contacts to physicians and involvement of the GP were low prior to unplanned transfers. The ranges between the NHs may be explained by organizational differences. Conclusion Improvements in communication between nursing staff, physicians and others are required to reduce potentially avoidable transfers. Electronic supplementary material The online version of this article (10.1007/s40520-020-01751-5) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Kim S, Kang H, Cho Y, Lee H, Lee SW, Jeong J, Kim WY, Kim SJ, Han KS. Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data. Clin Exp Emerg Med 2021; 8:128-136. [PMID: 34237818 PMCID: PMC8273668 DOI: 10.15441/ceem.20.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality. Conclusion Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.
Collapse
Affiliation(s)
- Soyoon Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Vuilleumier S, Fiorentino A, Dénéréaz S, Spichiger T. Identification of new demands regarding prehospital care based on 35,188 missions in 2018. BMC Emerg Med 2021; 21:63. [PMID: 34030660 PMCID: PMC8142491 DOI: 10.1186/s12873-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called "non-urgent"), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. METHOD The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. RESULTS The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern "non-urgent" situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. CONCLUSION The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics' skills to respond to the current needs.
Collapse
Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland.
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland
| | - Sandrine Dénéréaz
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| | - Thierry Spichiger
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| |
Collapse
|
17
|
Chen BA, Lai FC, Tsao LI, Chien HH, Chen CF, Jeng C. Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study. J Adv Nurs 2021; 77:2728-2738. [PMID: 33624335 DOI: 10.1111/jan.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
AIMS To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN A cross-sectional nationwide study. METHODS The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.
Collapse
Affiliation(s)
- Bor-An Chen
- Emergency Department, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.,Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Fu-Chih Lai
- Post-Baccalaureate Nursing Program in Nursing and College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Lee-Ing Tsao
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hui-Hui Chien
- Nursing Department, Yuanshan Branch, Taipei Veterans General Hospital, Ilan, Taiwan
| | - Chun-Fu Chen
- Taipei Medical University-Shuang HO Hospital, Ministry of Health and Welfare
| | - Chii Jeng
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
18
|
Mota-Romero E, Tallón-Martín B, García-Ruiz MP, Puente-Fernandez D, García-Caro MP, Montoya-Juarez R. Frailty, Complexity, and Priorities in the Use of Advanced Palliative Care Resources in Nursing Homes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:70. [PMID: 33466767 PMCID: PMC7830978 DOI: 10.3390/medicina57010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: This study aimed to determine the frailty, prognosis, complexity, and palliative care complexity of nursing home residents with palliative care needs and define the characteristics of the cases eligible for receiving advanced palliative care according to the resources available at each nursing home. Materials and Methods: In this multi-centre, descriptive, and cross-sectional study, trained nurses from eight nursing homes in southern Spain selected 149 residents with palliative care needs. The following instruments were used: the Frail-VIG index, the case complexity index (CCI), the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal), the palliative prognosis index, the Barthel index (dependency), Pfeiffer's test (cognitive impairment), and the Charlson comorbidity index. A consensus was reached on the complexity criteria of the Diagnostic Instrument of Complexity in Palliative Care that could be addressed in the nursing home (no priority) and those that required a one-off (priority 2) or full (priority 1) intervention of advanced palliative care resources. Non-parametric tests were used to compare non-priority patients and patients with some kind of priority. Results: A high percentage of residents presented frailty (80.6%), clinical complexity (80.5%), and palliative care complexity (65.8%). A lower percentage of residents had a poor prognosis (10.1%) and an extremely poor prognosis (2%). Twelve priority 1 and 14 priority 2 elements were identified as not matching the palliative care complexity elements that had been previously identified. Of the studied cases, 20.1% had priority 1 status and 38.3% had priority 2 status. Residents with some kind of priority had greater levels of dependency (p < 0.001), cognitive impairment (p < 0.001), and poorer prognoses (p < 0.001). Priority 1 patients exhibited higher rates of refractory delirium (p = 0.003), skin ulcers (p = 0.041), and dyspnoea (p = 0.020). Conclusions: The results indicate that there are high levels of frailty, clinical complexity, and palliative care complexity in nursing homes. The resources available at each nursing home must be considered to determine when advanced palliative care resources are required.
Collapse
Affiliation(s)
- Emilio Mota-Romero
- Primary Care Center Dr. Salvador Caballero García Andalusian, Health Service, Government of Andalusia, 18012 Granada, Andalusia, Spain;
| | | | | | - Daniel Puente-Fernandez
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Andalusia, Spain
| | - María P. García-Caro
- Department of Nursing, Mind, Brain and Behaviour Research Institute, University of Granada, 18016 Granada, Andalusia, Spain; (M.P.G.-C.); (R.M.-J.)
| | - Rafael Montoya-Juarez
- Department of Nursing, Mind, Brain and Behaviour Research Institute, University of Granada, 18016 Granada, Andalusia, Spain; (M.P.G.-C.); (R.M.-J.)
| |
Collapse
|
19
|
Nursing Home Residents' Functional Trajectories and Mortality After a Transfer to the Emergency Department. J Am Med Dir Assoc 2020; 22:393-398.e3. [PMID: 32660854 DOI: 10.1016/j.jamda.2020.05.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe nursing home residents' (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED). DESIGN Case-control observational multicenter study. SETTING AND PARTICIPANTS In total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016. METHODS Finite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions. RESULTS Trajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2‒time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness. CONCLUSIONS AND IMPLICATIONS Identified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.
Collapse
|
20
|
Fassmer AM, Hoffmann F. Acute health care services use among nursing home residents in Germany: a comparative analysis of out-of-hours medical care, emergency department visits and acute hospital admissions. Aging Clin Exp Res 2020; 32:1359-1368. [PMID: 31428997 DOI: 10.1007/s40520-019-01306-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nursing home (NH) residents often utilise acute health care services. However, comparative data on those are lacking. AIMS Investigating German NH residents' use of out-of-hours medical care (OOHC), visits to emergency departments (EDs) and acute hospital admissions (AHAs). METHODS Using claims data of 1665 residents for 2014-2015, we conducted a retrospective cohort study, examining the incidence rates involving the different services. Multivariate Poisson regression analyses were performed to calculate relative risks (RRs). Differences in the utilisations over the days of the week and of the reasons for contacts were assessed. RESULTS In total, 3576 contacts occurred (mean age 80.5 years, women 66.3%), resulting in an overall incidence rate of 2.7 per person-year (95% confidence interval 2.6-2.8). Strongest predictors were polypharmacy (RR 1.79; 95% CI 1.50-2.12), followed by male sex and higher care dependency. Among the three services AHAs showed the highest rates. Injuries were the most common reasons for visiting EDs, whereas for OOHC use and AHAs, coded diagnoses covered a broader spectrum. Utilisation of the services on weekdays varied, particularly for OOHC. DISCUSSION Polypharmacy, a higher care dependency and male sex seem to play a role in predicting acute health care services. Considering the distribution of the diagnoses of all three types, certain patterns concerning the symptoms' acuity become apparent. CONCLUSIONS Our findings revealed high acute health care services use among NH residents in Germany and differences among the three available services. This information can be used to design studies for investigating the appropriateness of these contacts.
Collapse
Affiliation(s)
- Alexander Maximilian Fassmer
- Department of Health Services Research, VI. School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany.
| | - Falk Hoffmann
- Department of Health Services Research, VI. School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| |
Collapse
|
21
|
Han KS, Kim WY, Kim SJ, Jeong J, Kang H, Lee C, Lee SW. Research for improvement of the national evaluation program for emergency medical center in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.4.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In Korea, the national evaluation program for emergency medical centers (EMCs) was introduced in 2003. EMCs in Korea have three levels of emergency centers including regional emergency centers, local emergency centers, and local emergency rooms. The evaluation system assesses the performance of EMCs at all three levels. The role of both regional emergency centers and local emergency centers administer the final treatment for severe emergency patients, although the definition of severe emergency patients is unclear. These factors may aggravate crowding at the emergency department. The national evaluation system aims to reduce the length of stay in the emergency department. However, reduction of the length of stay at emergency department may cause a conflict with the administration of final treatment for critically ill emergency patients owing to a lack of in-hospital beds. Crowding of the emergency department is not a problem of EMCs but that of the health system. In 2019, the Korean Society of Emergency Medicine performed a study to improve the national evaluation program for EMC and the performance of EMC. Here, we have summarized the results.
Collapse
|
22
|
Fassmer AM, Pulst A, Spreckelsen O, Hoffmann F. Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies. BMC FAMILY PRACTICE 2020; 21:29. [PMID: 32046652 PMCID: PMC7014634 DOI: 10.1186/s12875-020-01108-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Abstract
Background Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement. Methods Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests. Results We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492). Conclusions A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.
Collapse
Affiliation(s)
- Alexander Maximilian Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Alexandra Pulst
- Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
| | - Ove Spreckelsen
- Division of General Practice, Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| |
Collapse
|
23
|
Brickman KR, Silvestri JA. The emergency care model: A new paradigm for skilled nursing facilities. Geriatr Nurs 2019; 41:242-247. [PMID: 31669057 DOI: 10.1016/j.gerinurse.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
The population of individuals age 65 and older is increasing in the United States. One third of these individuals will utilize nursing home care before death. Nursing home residents ("NHR") average 1.8 emergency department visits annually. Improving the quality of nursing home care is of vital importance. This project describes a new paradigm for the management of acute emergent health issues affecting NHR. The model features a multidisciplinary team coordinated by emergency providers resulting in a 55% reduction in unplanned hospital admissions compared to skilled nursing facility regional data. Additionally, a reduction in ancillary lab costs was observed. Implementation of this paradigm on a national scale could result in a projected cost savings in excess of $10 billion per year for the Center for Medicare and Medicaid Services ("CMS").
Collapse
Affiliation(s)
- Kristopher R Brickman
- Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, United States.
| | - Joseph A Silvestri
- Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, United States
| |
Collapse
|
24
|
The Temporal Trend in the Transfer of Older Adults to the Emergency Department for Traumatic Injuries: A Retrospective Analysis According to Their Place of Residence. J Am Med Dir Assoc 2019; 20:1462-1466. [DOI: 10.1016/j.jamda.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/07/2023]
|
25
|
Leutgeb R, Berger SJ, Szecsenyi J, Laux G. Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare. BMJ Open 2019; 9:e025269. [PMID: 30670526 PMCID: PMC6347959 DOI: 10.1136/bmjopen-2018-025269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Demand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients. DESIGN Cross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg. SETTING One-year observation of hospitalisation patterns for NH and non-NH patients. PARTICIPANTS 3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered. METHODS Patient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models. RESULTS Of the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs). CONCLUSIONS Large numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.
Collapse
Affiliation(s)
- Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Jane Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
26
|
Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr 2019; 19:17. [PMID: 30665362 PMCID: PMC6341611 DOI: 10.1186/s12877-019-1028-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/04/2019] [Indexed: 01/08/2023] Open
Abstract
Background Elderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable. Methods Systematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract. Results Seventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital. Conclusions The definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs. Electronic supplementary material The online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sabine E Lemoyne
- Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Hanne H Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Dennis De Blick
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Peter Van Bogaert
- Center for Research and Innovation in Care, Universiteitsplein 1, 2610, Wilrijk, Belgium
| |
Collapse
|
27
|
Doupe MB, Poss J, Norton PG, Garland A, Dik N, Zinnick S, Lix LM. How well does the minimum data set measure healthcare use? a validation study. BMC Health Serv Res 2018; 18:279. [PMID: 29642929 PMCID: PMC5896092 DOI: 10.1186/s12913-018-3089-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/03/2018] [Indexed: 11/15/2022] Open
Abstract
Background To improve care, planners require accurate information about nursing home (NH) residents and their healthcare use. We evaluated how accurately measures of resident user status and healthcare use were captured in the Minimum Data Set (MDS) versus administrative data. Methods This retrospective observational cohort study was conducted on all NH residents (N = 8832) from Winnipeg, Manitoba, Canada, between April 1, 2011 and March 31, 2013. Six study measures exist. NH user status (newly admitted NH residents, those who transferred from one NH to another, and those who died) was measured using both MDS and administrative data. Rates of in-patient hospitalizations, emergency department (ED) visits without subsequent hospitalization, and physician examinations were also measured in each data source. We calculated the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and overall agreement (kappa, κ) of each measure as captured by MDS using administrative data as the reference source. Also for each measure, logistic regression tested if the level of disagreement between data systems was associated with resident age and sex plus NH owner-operator status. Results MDS accurately identified newly admitted residents (κ = 0.97), those who transferred between NHs (κ = 0.90), and those who died (κ = 0.95). Measures of healthcare use were captured less accurately by MDS, with high levels of both under-reporting and false positives (e.g., for in-patient hospitalizations sensitivity = 0.58, PPV = 0.45), and moderate overall agreement levels (e.g., κ = 0.39 for ED visits). Disagreement was sometimes greater for younger males, and for residents living in for-profit NHs. Conclusions MDS can be used as a stand-alone tool to accurately capture basic measures of NH use (admission, transfer, and death), and by proxy NH length of stay. As compared to administrative data, MDS does not accurately capture NH resident healthcare use. Research investigating these and other healthcare transitions by NH residents requires a combination of the MDS and administrative data systems. Electronic supplementary material The online version of this article (10.1186/s12913-018-3089-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Malcolm B Doupe
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
| | - Jeff Poss
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada
| | - Peter G Norton
- University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Allan Garland
- Faculty of Health Sciences, University of Manitoba, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Natalia Dik
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Shauna Zinnick
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, 4th floor, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| |
Collapse
|