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Tulchinsky I, Buckley R, Meek R, Lim JJY. Potentially avoidable emergency department transfers from residential aged care facilities for possible post-fall intracranial injury. Emerg Med Australas 2023; 35:41-47. [PMID: 35879249 PMCID: PMC10087771 DOI: 10.1111/1742-6723.14051] [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: 06/06/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post-fall. To describe rates of CT brain (CTB) performance, intracranial trauma-related findings, neurosurgical intervention, and patient outcome. METHODS Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made. RESULTS Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23-30] vs 20% [95% CI 15-25], P < 0.001) and anticoagulant use (59% [95% CI 55-63] vs 42% [95% CI 37-49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma-related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup. CONCLUSION Just over half of the RACF to ED transfers were classified as 'potentially avoidable'.
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Affiliation(s)
- Igor Tulchinsky
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Richard Buckley
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Robert Meek
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Joel Jun Yi Lim
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Potentially Inappropriate Medication among Older Patients Who Are Frequent Users of Outpatient Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030985. [PMID: 33499419 PMCID: PMC7908147 DOI: 10.3390/ijerph18030985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
Aging is accompanied by changes in organ degeneration, and susceptibility to multiple diseases, leading to the frequent occurrence of adverse drug reactions resulting from polypharmacy (PP) and potentially inappropriate medications (PIM) in older patients. This study employs a retrospective cohort design and investigates the association of PP with PIM among older patients with high rates of medical utilization. Using records from a national pharmaceutical care database, an experimental group is formed from patients meeting these criteria, who are then offered home pharmaceutical care. Correspondingly, a control group is formed by identifying older patients with regular levels of use of medical services who had been dispensed medications at community pharmacies. Multivariate logistic regression is performed to assess the association between the rate of PIM and variables, including age, gender, and PP. The study finds that experimental PP participants had a higher rate of PIM prescription (odds ratio (OR) = 5.4) than non-PP control participants (all p < 0.001). In clinical practice, additional caution is required to avoid PIMs. Patients engaged in continuously using long-term medication should take precautions in daily life to alleviate related discomforts. Pharmacists should serve as a bridge between patients and physicians to enhance their health and improve their quality of life.
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Ooi M, Lewis ET, Brisbane J, Tubb E, McClean T, Assareh H, Hillman K, Achat H, Cardona M. Feasibility of Using a Risk Assessment Tool to Predict Hospital Transfers or Death for Older People in Australian Residential Aged Care. A Retrospective Cohort Study. Healthcare (Basel) 2020; 8:E284. [PMID: 32825603 PMCID: PMC7551645 DOI: 10.3390/healthcare8030284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the feasibility of identifying an end-of-life risk profile among RACF residents using a predictive tool to better anticipate predictors of hospital transfers, death or poor composite outcome of hospitalisation and/or death after initial assessment. A retrospective cohort study of 373 permanent residents aged 65+ years was conducted using objective clinical factors from records in nine RACFs in metropolitan Sydney, Australia. In total, 26.8% died and 34.3% experienced a composite outcome. Cox proportional hazard regression models confirmed the feasibility of estimating the level of risk for death or a poor composite outcome. Knowing this should provide opportunities to initiate advance care planning in RACFs, facilitating decision making near the end of life. We conclude that the current structure of electronic RACF databases could be enhanced to enable comprehensive assessment of the risk of hospital re-attendance without admission. Automation tools to facilitate the risk score calculation may encourage the adoption of prediction checklists and evaluation of their association with hospital transfers.
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Affiliation(s)
- Meidelynn Ooi
- Medical School, The University of New South Wales, Kensington 2052, Australia;
| | - Ebony T Lewis
- School of Population Health, Faculty of Medicine, University of New South Wales, Kensington 2052, Australia;
- School of Psychology, Faculty of Science, University of New South Wales, Kensington 2052, Australia
| | - Julianne Brisbane
- Uniting (Aged Care Services), Sydney 2067, Australia; (J.B.); (E.T.); (T.M.)
| | - Evalynne Tubb
- Uniting (Aged Care Services), Sydney 2067, Australia; (J.B.); (E.T.); (T.M.)
| | - Tom McClean
- Uniting (Aged Care Services), Sydney 2067, Australia; (J.B.); (E.T.); (T.M.)
| | - Hassan Assareh
- Agency for Clinical Innovation, St Leonards 2065, Australia;
| | - Ken Hillman
- Intensive Care Unit, Liverpool Hospital, Liverpool 2170, Australia;
| | - Helen Achat
- Western Sydney Local Health District, North Parramatta 2151, Australia;
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast 4226, Australia
- EBP Professorial Unit, Gold Coast University Hospital, Southport 4215, Australia
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4
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Russell P, Laubscher S, Roberts GW, Mangoni AA, McDonald C, Hendrix I, Hewage U, Hofmann D, Michell S, Taeuber L, Woodman RJ, Shakib S, Crawford GB, Maddison J, Thompson C. A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital. Ther Adv Drug Saf 2019; 10:2042098619854876. [PMID: 31210924 PMCID: PMC6552337 DOI: 10.1177/2042098619854876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Patients from residential aged care facilities are commonly exposed to inappropriate polypharmacy. Unplanned inpatient admissions can provide an opportunity for review of complex medical regimens and deprescribing of inappropriate or nonbeneficial medications. The aim of this study was to assess the efficacy, safety and sustainability of in-hospital deprescribing. Methods: We followed a prospective, multi-centre, cohort study design, with enrolment of 106 medical inpatients age 75 years and older (mean age was 88.8 years) who were exposed to polypharmacy prior to admission and with a planned discharge to a nursing home for permanent placement. Descriptive statistics were calculated for relevant variables. The Short Form-8 (SF-8) health survey was used to assess changes in health-related quality of life (HRQOL) at 90-day follow up, in comparison with SF-8 results at day 30. Results: Deprescribing occurred in most, but not all patients. There were no differences between the groups in principal diagnosis, Charlson index, number of medications on admission or number of Beers list medications on admission. At 90 days, mortality and readmissions were similar, though the deprescribed group had significantly higher odds of better emotional wellbeing than the nondeprescribed group [odds ratio (OR) = 5.08, 95% confidence interval (CI): 1.93, 13.39; p = 0.001]. In the deprescribing group, 31% of the patients still alive at 90 days had medications restarted in primary care. One-year mortality rates were similar. Conclusions: Deprescribing medications during an unplanned hospital admission was not associated with mortality, readmissions, or overall HRQOL.
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Affiliation(s)
- Patrick Russell
- School of Medicine, Flinders University, Royal Adelaide Hospital, Adelaide, Australia
| | - Sara Laubscher
- Southern Adelaide Local Health Network, Adelaide, Australia
| | | | | | | | - Ivanka Hendrix
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Udul Hewage
- School of Medicine, Flinders University, Adelaide, Australia
| | - Dirk Hofmann
- School of Medicine, Flinders University, Adelaide, Australia
| | - Sophie Michell
- Southern Adelaide Local Health Network, Adelaide, Australia
| | - Lauren Taeuber
- Southern Adelaide Local Health Network, Adelaide, Australia
| | | | - Sepehr Shakib
- Discipline of Medicine, University of Adelaide, Australia
| | | | - John Maddison
- Discipline of Medicine, University of Adelaide, Australia
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Jain S, Gonski PN, Jarick J, Frese S, Gerrard S. Southcare Geriatric Flying Squad: an innovative Australian model providing acute care in residential aged care facilities. Intern Med J 2018; 48:88-91. [DOI: 10.1111/imj.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Shikha Jain
- Southcare, Aged and Extended Care; The Sutherland Hospital; Sydney New South Wales Australia
| | - Peter N. Gonski
- Southcare, Aged and Extended Care; The Sutherland Hospital; Sydney New South Wales Australia
| | - Jeannette Jarick
- Southcare, Aged and Extended Care; The Sutherland Hospital; Sydney New South Wales Australia
| | - Sandra Frese
- Southcare, Aged and Extended Care; The Sutherland Hospital; Sydney New South Wales Australia
| | - Sheena Gerrard
- Southcare, Aged and Extended Care; The Sutherland Hospital; Sydney New South Wales Australia
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6
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Wong HJ, Wang J, Grinman M, Wu RC. Goals of care discussions among hospitalized long-term care residents: Predictors and associated outcomes of care. J Hosp Med 2016; 11:824-831. [PMID: 27439318 DOI: 10.1002/jhm.2642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION There are limited data on the occurrence, predictors, and impact of goals of care (GOC) discussions during hospitalization for seriously ill elderly patients, particularly for long-term care (LTC) residents. METHODS The study was a retrospective chart review of 200 randomly sampled LTC residents hospitalized via the emergency department and admitted to the general internal medicine service of 2 Canadian academic hospitals, from January 2012 through December 2012. We applied logistic regression models to identify factors associated with, and outcomes of, these discussions. RESULTS Overall, 9.4% (665 of 7084) of hospitalizations were patients from LTC. In the sample of 200 patients, 37.5% had a documented discussion. No baseline patient characteristic was associated with GOC discussions. Low Glasgow Coma Scale, high respiratory rate, and low oxygen saturation were associated with discussions. Patients with discussions had higher rates of orders for no resuscitation (80% vs 55%) and orders for comfort measures only (7% vs 0%). In adjusted analyses, patients with discussions had higher odds of in-hospital death (52.0, 95% confidence interval [CI]: 6.2-440.4) and 1-year mortality (4.1, 95% CI: 1.7-9.6). Nearly 75% of patients with a change in their GOC did not have this documented in the discharge summary. CONCLUSION In hospitalized LTC patients, GOC discussions occurred infrequently and appeared to be triggered by illness severity. Orders for advance directives, in-hospital death, and 1-year mortality were associated with discussions. Rates of GOC documentation in the discharge summary were poor. This study provides direction for developing education and practice standards to improve GOC discussion rates and their communication back to LTC. Journal of Hospital Medicine 2015;11:824-831. © 2015 Society of Hospital Medicine.
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Affiliation(s)
- Hannah J Wong
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Jamie Wang
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Michelle Grinman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert C Wu
- Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Davis J, Shute J, Morgans A. Supporting a good life and death in residential aged care: an exploration of service use towards end of life. Int J Palliat Nurs 2016; 22:424-429. [PMID: 27666302 DOI: 10.12968/ijpn.2016.22.9.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The concept of a 'good death' involves end-of-life care in an appropriate setting and in keeping with the person's preferences. Limited research has examined the circumstances and place of death for older people living in residential aged care. OBJECTIVE This exploratory study investigated the nature of health service use and place of death of older people living in aged care to identify factors that lead to transfer of end-of-life care to other settings and poorer outcomes. METHODS Retrospective review of residential aged care client records between July 2014 and June 2015. CONCLUSION The majority of people in this study died in their home setting of residential care and a number were in receipt of palliative care prior to their deaths. The study proposes a national approach to the use of terminology and documents related to palliative and end-of-life care and education in assessment and recognition of nearing the end of life.
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Affiliation(s)
| | | | - Amee Morgans
- Principal Research Fellow, RDNS Institute Adjunct Senior Research Fellow, Monash University, Australia
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8
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Hopcroft P, Peel NM, Poudel A, Scott IA, Gray LC, Hubbard RE. Prescribing for older people discharged from the acute sector to residential aged-care facilities. Intern Med J 2015; 44:1034-7. [PMID: 25302723 DOI: 10.1111/imj.12553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper-polypharmacy (≥10 drugs) increasing from 24.3% to 32.5%. Many drugs were preventive medications whose time until benefit was likely to exceed the expected lifespan. In summary, frail patients continue to be exposed to extensive polypharmacy and medications with uncertain risk-benefit ratio.
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Affiliation(s)
- P Hopcroft
- Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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9
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Unplanned Transfer to Emergency Departments for Frail Elderly Residents of Aged Care Facilities: A Review of Patient and Organizational Factors. J Am Med Dir Assoc 2015; 16:551-62. [DOI: 10.1016/j.jamda.2015.03.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/07/2015] [Accepted: 03/05/2015] [Indexed: 12/20/2022]
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10
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Jokanovic N, Tan ECK, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc 2015; 16:535.e1-12. [PMID: 25869992 DOI: 10.1016/j.jamda.2015.03.003] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the prevalence of, and factors associated with, polypharmacy in long-term care facilities (LTCFs). METHODS MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library were searched from January 2000 to September 2014. Primary research studies in English were eligible for inclusion if they fulfilled the following criteria: (1) polypharmacy was quantitatively defined, (2) the prevalence of polypharmacy was reported or could be extracted from tables or figures, and (3) the study was conducted in a LTCF. Methodological quality was assessed using an adapted version of the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS Forty-four studies met the inclusion criteria and were included. Polypharmacy was most often defined as 5 or more (n = 11 studies), 9 (n = 13), or 10 (n = 11) medications. Prevalence varied widely between studies, with up to 91%, 74%, and 65% of residents taking more than 5, 9, and 10 medications, respectively. Seven studies performed multivariate analyses for factors associated with polypharmacy. Positive associations were found for recent hospital discharge (n = 2 studies), number of prescribers (n = 2), and comorbidity including circulatory diseases (n = 3), endocrine and metabolic disorders (n = 3), and neurological motor dysfunctioning (n = 3). Older age (n = 5), cognitive impairment (n = 3), disability in activities of daily living (n = 3), and length of stay in the LTCF (n = 3) were inversely associated with polypharmacy. CONCLUSIONS The prevalence of polypharmacy in LTCFs is high, varying widely between facilities, geographical locations and the definitions used. Greater use of multivariate analysis to investigate factors associated with polypharmacy across a range of settings is required. Longitudinal research is needed to explore how polypharmacy has evolved over time.
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Affiliation(s)
- Natali Jokanovic
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia; Pharmacy Department, Alfred Hospital, Melbourne, Australia.
| | - Edwin C K Tan
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Michael J Dooley
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia; Pharmacy Department, Alfred Hospital, Melbourne, Australia
| | - Carl M Kirkpatrick
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
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Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J. A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 2014; 43:759-66. [PMID: 25315230 DOI: 10.1093/ageing/afu117] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital. METHODS a comprehensive search of the peer-reviewed literature using four electronic databases. Inclusion criteria were participants lived in nursing homes, care homes or long-term care, aged at least 65 years, and studies reported outcomes of acute ED transfer or hospital admission. Findings were synthesized and key factors identified. RESULTS residents of RACF frequently presented severely unwell with multi-system disease. In-hospital complications included pressure ulcers and delirium, in 19 and 38% of residents, respectively; and up to 80% experienced potentially invasive interventions. Despite specialist emergency care, mortality was high with up to 34% dying in hospital. Furthermore, there was extensive use of healthcare resources with large proportions of residents undergoing emergency ambulance transport (up to 95%), and inpatient admission (up to 81%). CONCLUSIONS acute emergency department (ED) transfer is a considerable burden for residents of RACF. From available evidence, it is not clear if benefits of in-hospital emergency care outweigh potential adverse complications of transfer. Future research is needed to better understand patient-centred outcomes of transfer and to explore alternative models of emergency healthcare.
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Affiliation(s)
- Rosamond Dwyer
- Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia
| | - Belinda Gabbe
- Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia
| | - Johannes U Stoelwinder
- Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judy Lowthian
- Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia
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Cheang F, Finnegan T, Stewart C, Hession A, Clayton JM. Single-centre cross-sectional analysis of advance care planning among elderly inpatients. Intern Med J 2014; 44:967-74. [DOI: 10.1111/imj.12550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- F. Cheang
- Department of Palliative Care; Royal North Shore Hospital; Sydney New South Wales Australia
- Department of Aged Care; Royal North Shore Hospital; Sydney New South Wales Australia
- Department of Aged Care; Blacktown District Hospital; Sydney New South Wales Australia
- HammondCare Palliative and Supportive Care Service; Greenwich Hospital; Sydney New South Wales Australia
| | - T. Finnegan
- Department of Aged Care; Royal North Shore Hospital; Sydney New South Wales Australia
| | - C. Stewart
- Sydney Law School; University of Sydney; Sydney New South Wales Australia
| | - A. Hession
- HammondCare Palliative and Supportive Care Service; Greenwich Hospital; Sydney New South Wales Australia
| | - J. M. Clayton
- Department of Palliative Care; Royal North Shore Hospital; Sydney New South Wales Australia
- HammondCare Palliative and Supportive Care Service; Greenwich Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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13
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Reyniers T, Houttekier D, Cohen J, Pasman HR, Deliens L. What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses. Palliat Med 2014; 28:941-948. [PMID: 24534726 DOI: 10.1177/0269216314522317] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite a majority preferring not to die in hospital and health policies aimed at increasing home death, the proportion of hospital deaths remains high. Gaining insight into professional caregiver perspectives about what justifies them could be helpful in understanding the persistently high rates of such hospital admissions and hospital deaths. AIM To explore the perspectives of nurses from nursing homes, home care and hospitals, and family physicians concerning hospital admissions at the end of life and the circumstances in which they consider them to be justified. DESIGN Focus groups, transcribed verbatim and analysed using a constant comparative approach. SETTING/PARTICIPANTS Five focus groups were held with family physicians (n = 39), two focus groups (n = 16) with nurses from different care settings (nursing home, home care and hospital) and one with nursing home nurses (n = 7) in Belgium. RESULTS Participants indicated that although they considered death at home or in the nursing home of residence the most preferable outcome, there are a number of scenarios that they consider to justify a hospital admission at the end of life: when the patient prefers a hospital admission, when the caring capacity of the care setting is considered to be inadequate and when one of a number of acute medical situations occurs. CONCLUSION A number of situations have been identified in which nurses and family physicians consider a hospital admission to be justified. Adequate advance care planning and improved psychosocial support to both family and professional caregivers could reduce the number of hospital deaths.
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Affiliation(s)
- Thijs Reyniers
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - H Roeline Pasman
- EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
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14
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Lee JC, Ward HE. A formalised, more considered and ethical approach to resuscitation. Intern Med J 2013; 43:956. [DOI: 10.1111/imj.12221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/09/2013] [Indexed: 12/01/2022]
Affiliation(s)
- J. C. Lee
- Department of Nuclear Medicine; The Prince Charles Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - H. E. Ward
- Patient Safety and Quality Unit; The Prince Charles Hospital; Brisbane Queensland Australia
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