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Rousseau G, Thummel S, Vannier C, Paul Louis M, Debacq C, Ridoux C, Deneau P, Laribi S. Evaluation of the appropriateness of nursing home residents' transfer to emergency departments. Int Emerg Nurs 2023; 69:101312. [PMID: 37348235 DOI: 10.1016/j.ienj.2023.101312] [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: 04/05/2022] [Revised: 05/14/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION France is experiencing a steady increase in the number of residents living in nursing homes (NHs). Each year, 25% of these residents are hospitalized, half of them through emergency departments (EDs). A part of these transfers to EDs are unjustified and not without consequences. The first aim of our study is to evaluate the proportion of avoidable NHs resident transfer to EDs. METHODS An observational, prospective and multicentric study was conducted between January and August 2019 in the 6 EDs of a French county during 3 inclusion periods. A multidisciplinary expert panel determined the appropriateness of each ED transfer. The results were expressed in gross values and %. Expert agreement was assessed by Fleiss' kappa statistical measure. RESULTS Transfers were deemed avoidable in 12 to 35% of cases and appropriate in 53 to 81% of cases according to the experts. Fleiss' Kappa score on the concordance of the different experts' answers concerning the relevance of transfers was slight with k = 0.28 with a significant p-value (p < 0.0001). Infection could benefit of direct hospitalization whereas trauma/wound and acute heart/pulmonary failure are the most relevant reasons of presentation to the ED. CONCLUSIONS Too many ED transfers of NH residents remain avoidable. There is a disparity of results among the experts reflecting a limitation of this study related to the subjective nature of relevance. In a society where demographic projections predict a continuing aging population anywhere EDs are regularly crowded, it would be interesting to identify and prevent factors predisposing to ED transfer and consider alternative managements with a better geriatric and emergency physicians collaboration for this specific population.
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Affiliation(s)
| | - Simon Thummel
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
| | - Clara Vannier
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
| | | | - Camille Debacq
- Division of Geriatric Medicine, CHRU Tours, Tours, France
| | - Clément Ridoux
- Nursing home and Geriatric Medicine, CH Sainte-Maure de Touraine, Sainte Maure de Touraine, France
| | - Pierre Deneau
- Emergency Medicine Department, CHRU Tours, Tours, France
| | - Said Laribi
- Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France
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Marincowitz C, Preston L, Cantrell A, Tonkins M, Sabir L, Mason S. What influences decisions to transfer older care-home residents to the emergency department? A synthesis of qualitative reviews. Age Ageing 2022; 51:6834152. [PMID: 36413591 PMCID: PMC9681131 DOI: 10.1093/ageing/afac257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND care home residents aged over 65 have disproportionate rates of emergency department (ED) attendance and hospitalisation. Around 40% attendances may be avoidable, and hospitalisation is associated with harms. We synthesised the evidence available in qualitative systematic reviews of different stakeholders' experiences of decisions to transfer residents to the ED. METHODS six electronic databases, references and citations of included reviews and relevant policy documents were searched. Reviews of qualitative studies exploring factors that influenced care home staff, medical practitioners, residents' family or residents' experiences and factors influencing decisions to transfer residents to the ED were included. Thematic analysis was used to synthesise findings. RESULTS six previous reviews were included, which synthesised the findings of 34 primary studies encompassing 152 care home residents, 283 resident family members or carers and 447 care home staff. Of the primary studies, 19 were conducted in the North America, seven in Australia, five were conducted in Scandinavia, two in the United Kingdom and one in Holland. Three themes were identified: (i) power dynamics between residents, family members, care home staff and health care professionals (external to the care home) influence decisions; (ii) admission can be necessary; however, (iii) some decisions may be driven by factors other than clinical need. CONCLUSION transfer decisions are complex and are determined not just by changes in health status interventions aimed at reducing avoidable transfers need to address the key role family members have in transfer decisions, the medical legal fears of care home staff and barriers to accessing community services.
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Affiliation(s)
- Carl Marincowitz
- Address correspondence to: Carl Marincowitz, Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
| | - Louise Preston
- Health Economics and Decision Science, Health Services Research School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Anna Cantrell
- Health Economics and Decision Science, Health Services Research School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Michael Tonkins
- Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Lisa Sabir
- Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
| | - Suzanne Mason
- Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
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Harrad-Hyde F, Armstrong N, Williams CD. 'Weighing up risks': a model of care home staff decision-making about potential resident hospital transfers. Age Ageing 2022; 51:6649130. [PMID: 35871419 PMCID: PMC9308989 DOI: 10.1093/ageing/afac171] [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: 10/13/2021] [Revised: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background care home staff play a crucial role in managing residents’ health and responding to deteriorations. When deciding whether to transfer a resident to hospital, a careful consideration of the potential benefits and risks is required. Previous studies have identified factors that influence staff decision-making, yet few have moved beyond description to produce a conceptual model of the decision-making process. Objectives to develop a conceptual model to describe care home staff’s decision-making when faced with a resident who potentially requires a transfer to the hospital. Methods data collection occurred in England between May 2018 and November 2019, consisting of 28 semi-structured interviews with 30 members of care home staff across six care home sites and 113 hours of ethnographic observations, documentary analysis and informal conversations (with staff, residents, visiting families, friends and healthcare professionals) at three of these sites. Results a conceptual model of care home staff’s decision-making is presented. Except in situations that staff perceived to be urgent enough to require an immediate transfer, resident transfers tended to occur following a series of escalations. Care home staff made complex decisions in which they sought to balance a number of potential benefits and risks to: residents; staff (as decision-makers); social relationships; care home organisations and wider health and social care services. Conclusions during transfer decisions, care home staff make complex decisions in which they weigh up several forms of risk. The model presented offers a theoretical basis for interventions to support deteriorating care home residents and the staff responsible for their care.
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Affiliation(s)
- Fawn Harrad-Hyde
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Natalie Armstrong
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Christopher D Williams
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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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.
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Emergencies in Long-Term Care Services for the Elderly in Korea: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010066. [PMID: 31861787 PMCID: PMC6982261 DOI: 10.3390/ijerph17010066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/05/2019] [Accepted: 12/14/2019] [Indexed: 11/25/2022]
Abstract
This mixed-methods study explored ways to enhance the emergency response abilities of workers in long-term care services for the elderly. Based on different service types, we identify emergency situations and the response abilities of workers in long-term care services. Results indicated that there are more emergency situations in care facilities than in home care services. However, 71.3% of respondents in facilities said emergency response abilities were low compared to 44.2% of workers in home care services. Qualitative research identified six categories and 16 themes based on emotions experienced during emergencies and the challenges in determining solutions. The study confirms that there is a difference in emergency incidences and the coping abilities of workers in facilities and home services with high emergency incidence rates. Developing and applying guidelines for emergency response management by service type is recommended.
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Gurung A, Broadbent M, Bakon S, Hocking J, Glenwright A, Shaw C, Tweddell S, Clark S. Understanding registered nurse decision-making, communication and care delivery between emergency departments and residential aged care facilities: A research protocol. Australas J Ageing 2019; 39:277-282. [PMID: 31782254 DOI: 10.1111/ajag.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision-making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. METHODS The proposed mixed-method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. RESULTS The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs.
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Affiliation(s)
- Apil Gurung
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Shannon Bakon
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Julia Hocking
- Griffith University, Brisbane, Queensland, Australia
| | - Amanda Glenwright
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Christine Shaw
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sheryl Tweddell
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sean Clark
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
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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.
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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
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8
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The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18001319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractFrailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.
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Mäkelä P. "She doesn't want to go to hospital. That's one thing she hates": Collective performativity in avoidable nursing home to hospital transfers. J Eval Clin Pract 2018; 24:1041-1048. [PMID: 29968362 DOI: 10.1111/jep.12985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/29/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
Older people who live with a combination of conditions experience fluctuations over time, which others may interpret as a need for medical attention. For some nursing home residents, this results in transitions in and out of hospital. Such transfers may be arranged without expectation of improved quality of life, can be associated with significant morbidity and mortality, and may preclude end-of-life preferences. Factors affecting avoidable hospitalization for nursing home residents are not well understood. I aim to explore potential drivers, moving beyond deficit explanations relating to funding, training, and resources. I use a framework of analysis that firstly considers medicalization of frailty, as a state of vulnerability that provides focus for others' action. I then draw on Judith Butler's theory of performativity, to explore nursing homes as sites of identity work for staff, residents and families. I consider ways subjectivities can be effected through reiterative practice that is compelled by normative conventions. Trouble may arise when citational practice of health care staff, and performative acquiescence of residents and families, culminates in an inevitability of hospitalization when navigating grey areas of assumed clinical risk. Principles of coproduction could present a disruptive opening, to rework power asymmetries, and move toward aspirations for residents and their relatives to be at the centre of decisions about care.
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Affiliation(s)
- Petra Mäkelä
- University of Westminster, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
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10
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Laging B, Kenny A, Bauer M, Nay R. Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography. J Clin Nurs 2018; 27:1452-1463. [PMID: 29396884 DOI: 10.1111/jocn.14292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the recognition and assessment of resident deterioration in the nursing home setting. BACKGROUND There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident. DESIGN Critical ethnography. METHODS Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers. CONCLUSIONS Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.
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Affiliation(s)
- Bridget Laging
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia
| | - Amanda Kenny
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Rhonda Nay
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
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Park E, Kim MS, Kang KN, Lee SJ, Chang SO. How do nurses recognize subtle signs of stroke and minimize serious damage in older residents of nursing homes? Collegian 2016. [DOI: 10.1016/j.colegn.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsai HH, Tsai YF, Huang HL. Nursing home nurses’ experiences of resident transfers to the emergency department: no empathy for our work environment difficulties. J Clin Nurs 2016; 25:610-8. [DOI: 10.1111/jocn.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Yun-Fang Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
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13
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Laging B, Bauer M, Ford R, Nay R. Decision to transfer to hospital from the residential aged care setting: a systematic review of qualitative evidence exploring residential aged care staff experiences. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Reid RC, Cummings GE, Cooper SL, Abel SL, Bissell LJ, Estabrooks CA, Rowe BH, Wagg A, Norton PG, Ertel M, Cummings GG. The Older Persons' Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool. BMC Health Serv Res 2013; 13:515. [PMID: 24330805 PMCID: PMC3867622 DOI: 10.1186/1472-6963-13-515] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 12/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background OPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-irsc.gc.ca/e/34348.html) study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3). Methods The pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing. Results Residents were elderly (mean age = 87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings. Conclusions While most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Greta G Cummings
- Faculty of Nursing, University of Alberta, 5-110 Edmonton Clinical Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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Briggs R, Coughlan T, Collins R, O'Neill D, Kennelly SP. Nursing home residents attending the emergency department: clinical characteristics and outcomes. QJM 2013; 106:803-8. [PMID: 23818688 DOI: 10.1093/qjmed/hct136] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nursing home (NH) residents represent the frailest group of older people, and providing gerontologically attuned care that addresses these frailties is often a challenge within the emergency department (ED). This study sought to prospectively profile acutely unwell NH residents in order to clarify some of the challenges of providing emergency care to this group. Over an 18-week period, we prospectively reviewed all NH residents presenting to the ED of an urban university teaching hospital. Relevant data were retrieved by direct physician review (as part of a comprehensive geriatric assessment in the ED), collateral history from NH staff and primary carers, and review of electronic records. There were 155 ED visits by 116 NH residents. Their mean age was 80.3 (±9.6) years. High pre-morbid levels of dependency were reflected by a mean Barthel Index of 34.1 (±20) and almost two-thirds had a pre-existing diagnosis of dementia. One-third of visits were during 'normal' working hours. Patients were reviewed by their regular NH doctor pre-transfer for 36% of visits. Using accepted international criteria, over half of the visits were deemed 'potentially preventable'. Unwell NH residents have complex medical needs. The decision to refer these patients to the ED is often made by 'out of hours' general practitioners and their initial care in the ED is directed by physicians with limited experience in geriatric medicine. Most referrals to the ED are potentially preventable but this would require enhancements to the package of care available in NHs.
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Affiliation(s)
- R Briggs
- Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
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16
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Arendts G, Quine S, Howard K. Decision to transfer to an emergency department from residential aged care: A systematic review of qualitative research. Geriatr Gerontol Int 2013; 13:825-33. [DOI: 10.1111/ggi.12053] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Susan Quine
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
| | - Kirsten Howard
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
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Robinson CA, Bottorff JL, Lilly MB, Reid C, Abel S, Lo M, Cummings GG. Stakeholder perspectives on transitions of nursing home residents to hospital emergency departments and back in two Canadian provinces. J Aging Stud 2012; 26:419-27. [PMID: 22939538 DOI: 10.1016/j.jaging.2012.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/15/2012] [Accepted: 06/04/2012] [Indexed: 11/25/2022]
Abstract
Major gaps exist in our understanding of transitions in care for older persons living in nursing homes. The purpose of the study was to identify key elements, from multiple stakeholder perspectives, that influence the success of transitions experienced by nursing home residents when they required transfer to a hospital emergency department. This interpretive descriptive study was conducted in two cities in the Canadian provinces of British Columbia and Alberta. Data were collected from 71 participants via focus groups and individual interviews with nursing home residents, family members, and professional healthcare providers working in nursing homes, emergency departments, and emergency medical services. Transcripts were analyzed using constant comparison. The elements contributing to the success of transitions reflected a patient- and family-centered approach to care. Transitions were influenced by the complex interplay of multiple elements that included: knowing the resident; critical geriatric knowledge and skilled assessment; positive relationships; effective communication; and timeliness. When one or more of the elements was absent or compromised, the success of the transition was also compromised. There was consistency about the importance of all the identified elements across all stakeholder groups whether they are residents, family members, or health professionals in nursing homes, emergency departments or emergency medical services. Aspects of many of these elements are modifiable and suggest viable targets for interventions aimed at improving the success of transitions for this vulnerable population.
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Affiliation(s)
- C A Robinson
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 3333 University Way, Kelowna, BC, Canada.
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Howard K, Arendts G, Jan S, Beck M. PROSpER: PReferences for the Organisation of acute health Services for oldER people: protocol for a mixed methods study. BMJ Open 2012; 2:e001081. [PMID: 22466038 PMCID: PMC3317141 DOI: 10.1136/bmjopen-2012-001081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Organisation of acute care services for people living in residential aged care facilities (RACF) is a complex area of health policy. For people living in RACF, the emergency department is often used to provide acute care; needs of RACF residents, however, are not always well met. Alternative models of delivering care must be acceptable to a variety of stakeholders; however, little is known about the values and preferences that people attach to aspects of how and where care is delivered. METHODS/DESIGN The PROSpER Study examines people's preferences for the organisation of acute healthcare services for older people in RACF. The authors aim to (1) determine which factors influence preferences of residents, carers and providers for how and where acute care is delivered and (2) determine the relative importance of these factors and the acceptable trade-offs between them. Qualitative and quantitative methods will be used. One-on-one interviews will be conducted with RACF residents, their families, staff of RACF and emergency department staff. A discrete choice study will then be designed to quantitatively assess preferences for alternative models of care delivery. Approximately 600 respondents from three respondent groups will be surveyed: older people living in RACF, family members of aged care residents and staff of RACF. A mixed logit model will be used; results will be expressed as parameter estimates (β) and odds of choosing one option over an alternative. Trade-offs between attributes will also be calculated. ETHICS AND DISSEMINATION The PROSpER Study has been approved by the University of Sydney, Human Research Ethics Committee (Protocol numbers 10653 and 14382) and Royal Perth Hospital Ethics Committee (reference 2009/045). Results will be published in peer-reviewed scientific journals and via conference presentations; a newsletter will also be provided to study participants. A stakeholder roundtable will also be held to discuss the results.
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Affiliation(s)
- Kirsten Howard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Glenn Arendts
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Western Australia, Australia
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia
| | - Stephen Jan
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Matthew Beck
- Institute for Transport and Logistics Studies, University of Sydney, Sydney, New South Wales, Australia
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A Survey of Emergency Department Staff About Challenges and Recommendations for Emergency Department Care of Extended Care Facility Patients. J Am Med Dir Assoc 2012; 13:143-50. [DOI: 10.1016/j.jamda.2010.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/28/2010] [Accepted: 05/28/2010] [Indexed: 11/22/2022]
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Laging B, Bauer M, Nay R, Ford R. A systematic review on the experiences of Residential Aged Care Facility staff decision making regarding the transfer of residents to Emergency Departments. JBI LIBRARY OF SYSTEMATIC REVIEWS 2012; 10:1-15. [PMID: 27820395 DOI: 10.11124/jbisrir-2012-302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Bridget Laging
- 1. Australian Centre for Evidence Based Aged Care, La Trobe University/Australian Catholic University, Melbourne Australia 2. La Trobe University, Melbourne Australia 3. Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne Australia 4. Australian Catholic University, Melbourne Australia
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Wang HE, Shah MN, Allman RM, Kilgore M. Emergency department visits by nursing home residents in the United States. J Am Geriatr Soc 2011; 59:1864-72. [PMID: 22091500 DOI: 10.1111/j.1532-5415.2011.03587.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To characterize emergency department (ED) use by nursing home residents in the United States. DESIGN Analysis of the National Hospital Ambulatory Medical Care Survey. SETTING U.S. EDs from 2005 to 2008. PARTICIPANTS Individuals visiting U.S. EDs stratified according to nursing home residency. MEASUREMENTS All ED visits by nursing home residents were identified. The demographic and clinical characteristics and ED resource utilization, length of stay, and outcomes of nursing home residents and nonresidents were compared. RESULTS During 2005 to 2008, nursing home residents accounted for 9,104,735 of 475,077,828 U.S. ED visits (1.9%; 95% confidence interval (CI) = 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were older (mean age 76.7, 95% CI = 75.8-77.5), female (63.3%), and non-Hispanic white (74.8%). Nursing home residents were more likely to have been discharged from the hospital in the prior 7 days (adjusted odds ratio (aOR = 1.4, 95% CI = 1.1-1.9), to present with fever (aOR = 1.9, 95% CI = 1.5-2.4) or hypotension (systolic blood pressure ≤90 mmHg, aOR = 1.8, 95% CI = 1.5-2.2), and to receive diagnostic tests (OR = 1.9, 95% CI = 1.6-2.2), imaging (OR = 1.5, 95% CI = 1.3-1.7), or procedures (OR = 1.6, 95% CI = 1.4-1.7) in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Nursing home residents were more likely to be admitted to the hospital (aOR = 1.8, 95% CI = 1.6-2.0) and to die (aOR = 2.3, 95% CI = 1.6-3.3). CONCLUSION Nursing home residents account for more than 2.2 million ED visits annually in the United States. Nursing home residents have greater medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the United States.
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Affiliation(s)
- Henry E Wang
- Department of Emergency Medicine, University of Alabama, Birmingham, Alabama 35249, USA.
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Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the emergency department be avoided through improved primary care services? Data from qualitative interviews. Australas J Ageing 2010; 29:61-5. [PMID: 20553535 DOI: 10.1111/j.1741-6612.2009.00415.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To explore the factors that influence the transfer of patients from residential aged care facilities (RACF) to hospital emergency departments (ED), and describe features of improved primary care in RACF that could result in reduced transfer. METHODS a. Three focus groups conducted with family and carers of RACF residents, along with RACF, ED and general practice staff. b. Semistructured one-on-one interviews with nine residents of RACF. RESULTS Five main themes emerged--staffing and skill mix in RACF, treatment options in RACF, end of life decision-making, communication and bureaucratic requirements. Analysis of the semistructured interviews demonstrated parallel concerns with many of the focus groups indicators. There was a strong but not universal preference among residents to minimise RACF to ED transfer. CONCLUSIONS The transfer of residents from RACF to ED is influenced by multiple interrelated factors, and strategies to reduce transfer should address these.
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Affiliation(s)
- Glenn Arendts
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research and University of Western Australia, Perth, Western Australia, Australia.
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Abstract
There is an absence of concept analysis discussing: "Who is the emergency room patient?" in the literature. This study aims to clarify and conceptually develop these concepts as they are contextually mediated. Using the evolutionary method of Rodgers (Concept Development in Nursing: Foundations, Techniques, and Applications. 2000:77-127), the findings clearly identified the references, contextual basis, attributes, antecedents, and consequences of the concepts. Clarity of the concepts is important as they could greatly influence future developments in practice, theory, and research.
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McCloskey R, Campo M, Savage R, Mandville-Anstey S. A conceptual framework for understanding interorganizational relationships between nursing homes and emergency departments: examples from the Canadian setting. Policy Polit Nurs Pract 2009; 10:285-294. [PMID: 20047921 DOI: 10.1177/1527154409357795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nursing home residents who experience exacerbations of chronic health conditions or new illnesses must generally go to the emergency department for health care. This reliance on two distinct settings of care requires organizations to engage in an interorganizational relationship, which can be problematic, particularly when each organization has its own governing structures, policies, practices, and culture. Although it is widely acknowledged that interorganizational relationships can be the source of much frustration and conflict, little is known about their underpinnings. In this article, the authors draw on the literature to explore the interorganizational relationship that emerges each time a resident transfers between a nursing home and an emergency department in Canada. The authors apply this knowledge to develop a conceptual model that can be used to explore other interorganizational relationships that are formed when patients move between settings of care.
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Affiliation(s)
- Rose McCloskey
- University of New Brunswick-Saint John, Saint John, New Brunswick, Canada.
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Rolland Y, Abellan van Kan G, Hermabessiere S, Gerard S, Guyonnet Gillette S, Vellas B. Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 2009; 13:679-83. [PMID: 19657550 DOI: 10.1007/s12603-009-0197-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To date, very little research has been carried out in nursing homes and it is difficult to make recommendations for quality of care that are based on actual data. The Réseau de Recherche en Etablissement d'Hébergement pour Personnes Agées (REHPA) is a functional network established in collaboration between the geriatric department of Toulouse University Hospital and 240 nursing homes with the aim of compensating for the lack of evidence-based recommendations and of enhancing research. MATERIALS AND METHODS A cross-sectional observational study was conducted between January and March 2008. The number of residents included (randomly selected by birth date) depended on the total number of residents of the facility. Demography, medical and drug history, disabilities and care practices were assessed by geriatrician. RESULTS We report the findings in 4896 residents of 240 nursing homes. Residents were 73.9% women, mean age 85.7 +/- 8.8 years, mean weight 61.9 +/- 14.8 kg, with a mean ADL score of 2.8 +/- 2.1. Dementia was diagnosed in 43.5% (of whom only 50.9% were treated), 19.6% showed aggressive behaviours, 10.8% exhibited disruptive vocalization and 10.9% were wanderers, 27.4% were treated with antipsychotic medications, 54.4% had hypertension, 8.7% had diabetes, 14.8% were osteoporotic, 4.1% had fallen during the previous week, 37.9% were in pain and 19.8% had lost weight. The mean Charlson index score was 1.6 +/- 1.4. Finally, 13.5% had been admitted to hospital within the previous three months. CONCLUSION The survey identifies specific issues in order to target future research in the nursing home setting.
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Affiliation(s)
- Y Rolland
- Gérontopôle de Toulouse, Service de Médecine Interne et de Gérontologie Clinique, Pavillon Junot, 170 avenue de Casselardit, Hôpital La Grave-Casselardit, 31300 Toulouse, France.
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