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Han MX, Ross L, Hemingway L, Anderson D, Gosling C. Out-of-hospital paramedic interactions with people living with dementia: a scoping review. Age Ageing 2024; 53:afae143. [PMID: 38994589 DOI: 10.1093/ageing/afae143] [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: 11/17/2023] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Dementia encompasses neurodegenerative disorders that account for a global estimated healthcare expenditure of 1.3 trillion US dollars. In Australia, one in 12 people aged ≥65 has a diagnosis of dementia and it is the second leading cause of death. Paramedics play a crucial role in person-centred dementia care, particularly in the community. While consensus has been established on paramedicine's integration into interdisciplinary care teams, there remains a lack of clarity regarding the paramedic role in dementia care. OBJECTIVE This study aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting. DESIGN AND SETTING This was a scoping review study of paramedics and people living with dementia within the out-of-hospital setting. METHODS This study was guided by the Joanna Briggs Institute (JBI) scoping review framework. Databases were searched without date limits, up to 4 April 2023. These encompassed OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English and reporting on paramedic-specific interactions with people living with dementia in the out-of-hospital setting. Data extraction was performed based on study setting, design, population and key findings. RESULTS Twenty-nine articles were included in the thematic analysis. Four themes emerged: need for training, patterns of attendances, patterns of documentation and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and unprepared in caring for patients living with dementia due to challenges in assessment and management of caregiver tensions. They were often called as a last resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated. Underdocumentation of dementia and pain was found. CONCLUSION Emergency ambulance conveyance of people living with dementia is a surface reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to improve paramedic training in dementia-specific skillsets.
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Affiliation(s)
- Ming Xuan Han
- Department of Paramedicine, Monash University Peninsula Campus, Frankston, Victoria 3199, Australia
| | - Linda Ross
- Department of Paramedicine, Monash University Peninsula Campus, Frankston, Victoria 3199, Australia
| | - Liam Hemingway
- Department of Paramedicine, Monash University Peninsula Campus, Frankston, Victoria 3199, Australia
| | - David Anderson
- Department of Paramedicine, Monash University Peninsula Campus, Frankston, Victoria 3199, Australia
- Ambulance Victoria, Doncaster, Victoria 3108, Australia
| | - Cameron Gosling
- Department of Paramedicine, Monash University Peninsula Campus, Frankston, Victoria 3199, Australia
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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.
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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
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Wiik AB, Doupe MB, Bakken MS, Kittang BR, Jacobsen FF, Førland O. Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study. BMC Health Serv Res 2024; 24:374. [PMID: 38532452 PMCID: PMC10964583 DOI: 10.1186/s12913-024-10879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. METHODS A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. RESULTS Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. CONCLUSIONS Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.
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Affiliation(s)
- Arne Bastian Wiik
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway.
| | - Malcolm Bray Doupe
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Marit Stordal Bakken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Bård Reiakvam Kittang
- University of Bergen, Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
| | - Oddvar Førland
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
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Özkaytan Y, Kukla H, Schulz-Nieswandt F, Zank S. We need a radical change to take place now´-The potential of integrated healthcare for rural long-term care facilities. Geriatr Nurs 2024; 56:270-277. [PMID: 38402806 DOI: 10.1016/j.gerinurse.2024.02.022] [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: 12/27/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study explores healthcare professionals' perceptions in rural German long-term care facilities, focusing on integrated health systems. The aim is to understand experiences, challenges, and preferences. METHODS Twenty nurses and paramedics participated in in-depth interviews. Thematic analysis was applied to transcripts, revealing key themes: acute healthcare provision, interdisciplinary collaboration, telemedicine use, and preferences for the future healthcare landscape. RESULTS Themes highlighted factors influencing acute care situations and the crucial role of interdisciplinary collaboration. Integrated care was infrequently encountered despite high demand in rural long-term care facilities. CONCLUSIONS Though uncommon, integrated healthcare remains crucial in addressing long-term care facility residents' complex needs. Healthcare professionals express a strong demand for integrated care in rural areas, citing potential benefits for resident wellbeing, healthcare effectiveness, and job satisfaction. The findings guide healthcare organizations in developing institutional-level strategies for integrated care integration, emphasizing its importance in rural settings.
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Affiliation(s)
- Yasemin Özkaytan
- Faculty of Human Sciences, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany.
| | - Helena Kukla
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Frank Schulz-Nieswandt
- Department of Social Policy and Methods of Qualitative Social Research, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Susanne Zank
- Faculty of Human Sciences, Rehabilitative Gerontology, University of Cologne, Germany
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Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37916580 DOI: 10.3310/klpw6338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Care homes predominantly care for older people with complex health and care needs, who are at high risk of unplanned hospital admissions. While often necessary, such admissions can be distressing and provide an opportunity cost as well as a financial cost. Objectives Our objective was to update a 2014 evidence review of interventions to reduce unplanned admissions of care home residents. We carried out a systematic review of interventions used in the UK and other high-income countries by synthesising evidence of effects of these interventions on hospital admissions; feasibility and acceptability; costs and value for money; and factors affecting applicability of international evidence to UK settings. Data sources We searched the following databases in December 2021 for studies published since 2014: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Health Management Information Consortium; Medline; PsycINFO; Science and Social Sciences Citation Indexes; Social Care Online; and Social Service Abstracts. 'Grey' literature (January 2022) and citations were searched and reference lists were checked. Methods We included studies of any design reporting interventions delivered in care homes (with or without nursing) or hospitals to reduce unplanned hospital admissions. A taxonomy of interventions was developed from an initial scoping search. Outcomes of interest included measures of effect on unplanned admissions among care home residents; barriers/facilitators to implementation in a UK setting and acceptability to care home residents, their families and staff. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. We used published frameworks to extract data on intervention characteristics, implementation barriers/facilitators and applicability of international evidence. We performed a narrative synthesis grouped by intervention type and setting. Overall strength of evidence for admission reduction was assessed using a framework based on study design, study numbers and direction of effect. Results We included 124 publications/reports (30 from the UK). Integrated care and quality improvement programmes providing additional support to care homes (e.g. the English Care Homes Vanguard initiatives and hospital-based services in Australia) appeared to reduce unplanned admissions relative to usual care. Simpler training and staff development initiatives showed mixed results, as did interventions aimed at tackling specific problems (e.g. medication review). Advance care planning was key to the success of most quality improvement programmes but do-not-hospitalise orders were problematic. Qualitative research identified tensions affecting decision-making involving paramedics, care home staff and residents/family carers. The best way to reduce end-of-life admissions through access to palliative care was unclear in the face of inconsistent and generally low-quality evidence. Conclusions Effective implementation of interventions at various stages of residents' care pathways may reduce unplanned admissions. Most interventions are complex and require adaptation to local contexts. Work at the interface between health and social care is key to successful implementation. Limitations Much of the evidence identified was of low quality because of factors such as uncontrolled study designs and small sample size. Meta-analysis was not possible. Future work We identified a need for improved economic evidence and the evaluation of integrated care models of the type delivered by hospital-based teams. Researchers should carefully consider what is realistic in terms of study design and data collection given the current context of extreme pressure on care homes. Study registration This study is registered as PROSPERO database CRD42021289418. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (award number NIHR133884) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carl Marincowitz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
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Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. J Am Med Dir Assoc 2023; 24:609-618.e6. [PMID: 36898411 DOI: 10.1016/j.jamda.2023.01.030] [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: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS Newly admitted or deceased residents. METHODS We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Affiliation(s)
- Alexander M Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany.
| | - Katharina Allers
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jasmin Helbach
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael Freitag
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Division of Geriatrics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
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7
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Primc N, Schwabe S, Poeck J, Günther A, Hasseler M, Rubeis G. A typology of nurses' interaction with relatives in emergency situations. Nurs Ethics 2023; 30:232-244. [PMID: 36314501 PMCID: PMC10014892 DOI: 10.1177/09697330221128902] [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: 11/05/2022]
Abstract
BACKGROUND In nursing homes, residents' relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. RESEARCH OBJECTIVES The present analysis aimed at elaborating a typology of nurses' experience of ethical support and challenges in their interaction with relatives in emergency situations. RESEARCH DESIGN Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring's method of qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Participants were licensed nurses working in nursing homes. ETHICAL CONSIDERATIONS Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. FINDINGS/RESULTS In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives' demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives' demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. CONCLUSIONS Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.
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Affiliation(s)
- Nadia Primc
- Institute of History and Ethics of Medicine, 9144University of Heidelberg, Heidelberg, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, 9177Hannover Medical School, Hanover, Germany
| | - Juliane Poeck
- Institute of General Practice, 39065University Hospital Jena, Jena, Germany
| | - Andreas Günther
- Fire Department, 524823City of Braunschweig, Braunschweig Germany
| | - Martina Hasseler
- Faculty of Health Sciences, 120199Ostfalia University of Applied Sciences, Wolfenbüttel Germany
| | - Giovanni Rubeis
- Division Biomedical and Public Health Ethics, 467773Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
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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.
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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
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9
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Kontunen PJ, Holstein RM, Torkki PM, Lang ES, Castrén MK. Acute outreach service to nursing homes: A systematic review with GRADE and triple aim approach. Scand J Caring Sci 2023; 37:582-594. [PMID: 36718539 DOI: 10.1111/scs.13148] [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] [Received: 09/23/2022] [Revised: 11/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED. AIMS We aim to assess the performance of acute care services provided to people living in nursing homes or long-term homecare, focusing on ED transfer prevention, safety, cost-effectiveness and experiences. MATERIALS & METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were eligible for inclusion if they were peer-reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long-term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins-I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE. RESULTS Fifteen relevant original studies were found-all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low. CONCLUSION Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster-randomised or quasi-experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost-effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020.
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Affiliation(s)
- Perttu J Kontunen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ria M Holstein
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Paulus M Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicin, University of Calgary, Calgary, Canada.,Alberta Health Service, Edmonton, Canada
| | - Maaret K Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Wu RMX, Wang Y, Shafiabady N, Zhang H, Yan W, Gou J, Shi Y, Liu B, Gide E, Kang C, Zhang Z, Shen B, Li X, Fan J, He X, Soar J, Zhao H, Sun L, Huo W, Wang Y. Using multi-focus group method as an effective tool for eliciting business system requirements: Verified by a case study. PLoS One 2023; 18:e0281603. [PMID: 36897871 PMCID: PMC10027421 DOI: 10.1371/journal.pone.0281603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
This research aims to explore the multi-focus group method as an effective tool for systematically eliciting business requirements for business information system (BIS) projects. During the COVID-19 crisis, many businesses plan to transform their businesses into digital businesses. Business managers face a critical challenge: they do not know much about detailed system requirements and what they want for digital transformation requirements. Among many approaches used for understanding business requirements, the focus group method has been used to help elicit BIS needs over the past 30 years. However, most focus group studies about research practices mainly focus on a particular disciplinary field, such as social, biomedical, and health research. Limited research reported using the multi-focus group method to elicit business system requirements. There is a need to fill this research gap. A case study is conducted to verify that the multi-focus group method might effectively explore detailed system requirements to cover the Case Study business's needs from transforming the existing systems into a visual warning system. The research outcomes verify that the multi-focus group method might effectively explore the detailed system requirements to cover the business's needs. This research identifies that the multi-focus group method is especially suitable for investigating less well-studied, no previous evidence, or unstudied research topics. As a result, an innovative visual warning system was successfully deployed based on the multi-focus studies for user acceptance testing in the Case Study mine in Feb 2022. The main contribution is that this research verifies the multi-focus group method might be an effective tool for systematically eliciting business requirements. Another contribution is to develop a flowchart for adding to Systems Analysis & Design course in information system education, which may guide BIS students step by step on using the multi-focus group method to explore business system requirements in practice.
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Affiliation(s)
- Robert M X Wu
- School of Engineering and Technology, Central Queensland University, Sydney, Australia
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Yongwen Wang
- Shanxi Fenxi Mining Industry (Group) Co. Ltd, China
| | - Niusha Shafiabady
- Faculty of Science and Technology (Sydney Campus), Charles Darwin University, Darwin, Australia
| | - Huan Zhang
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Wanjun Yan
- Shanxi Fenxi Mining Industry (Group) Co. Ltd, China
| | - Jinwen Gou
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Yong Shi
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Bao Liu
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Ergun Gide
- School of Engineering and Technology, Central Queensland University, Sydney, Australia
| | - Changlong Kang
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Zhongwu Zhang
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Bo Shen
- GENEW Technologies Co. Ltd, China
| | | | - Jianfeng Fan
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Xiangqian He
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Australia
| | - Haijun Zhao
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Lei Sun
- Shanxi Fenxi Mining Zhongxing Coal Industry Co. Ltd, China
| | - Wenying Huo
- School of Geography, Shanxi Normal University, Taiyuan, China
| | - Ya Wang
- Shanxi Kailain Technology Co. Ltd, China
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11
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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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12
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Surakka LK, Hökkä M, Törrönen K, Mäntyselkä P, Lehto JT. Paramedics' experiences and educational needs when participating end-of-life care at home: A mixed method study. Palliat Med 2022; 36:1217-1227. [PMID: 35922966 DOI: 10.1177/02692163221105593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. AIM To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. DESIGN A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. SETTING/PARTICIPANTS The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. RESULTS Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. CONCLUSIONS Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future.
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Affiliation(s)
- Leena K Surakka
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Siun Sote - North Karelia Social and Health Services Joint Authority, Palliative Care Center, Joensuu, Finland
| | - Minna Hökkä
- Kajaani University of Applied Sciences, Kajaani, Finland.,Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kari Törrönen
- Fire and Rescue Department, Siun Sote - North Karelia Social and Health Services Joint Authority, Joensuu, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Oncology, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
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13
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Marincowitz C, Preston L, Cantrell A, Tonkins M, Sabir L, Mason S. Factors associated with increased Emergency Department transfer in older long-term care residents: a systematic review. THE LANCET. HEALTHY LONGEVITY 2022; 3:e437-e447. [PMID: 36098321 DOI: 10.1016/s2666-7568(22)00113-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/15/2023] Open
Abstract
The proportion of adults older than 65 years is rapidly increasing. Care home residents in this age group have disproportionate rates of transfer to the Emergency Department (ED) and around 40% of attendances might be avoidable. We did a systematic review to identify factors that predict ED transfer from care homes. Six electronic databases were searched. Observational studies that provided estimates of association between ED attendance and variables at a resident or care home level were included. 26 primary studies met the inclusion criteria. Seven common domains of factors assessed for association with ED transfer were identified and within these domains, male sex, age, presence of specific comorbidities, polypharmacy, rural location, and care home quality rating were associated with likelihood of ED transfer. The identification of these factors provides useful information for policy makers and researchers intending to either develop interventions to reduce hospitalisations or use adjusted rates of hospitalisation as a care home quality indicator.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Louise Preston
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Tonkins
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lisa Sabir
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Suzanne Mason
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
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14
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Gurung A, Romeo M, Clark S, Hocking J, Dhollande S, Broadbent M. The enigma: Decision-making to transfer residents to the emergency department; communication and care delivery between emergency department staff and residential aged care facilities' nurses. Australas J Ageing 2022; 41:e348-e355. [PMID: 35187797 DOI: 10.1111/ajag.13044] [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: 06/29/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the experience of nurses involved in decision-making to transfer residents from a residential aged care facility (RACF) to their local hospital emergency department. This paper reports on the findings of the second phase of a two-phase study. METHODS Qualitative semi-structured interviews with 19 aged care nurses were conducted. Interviews were audio-taped and transcribed verbatim, and a thematic analysis was carried out. RESULTS The analysis revealed five major themes that influenced decision-making in relation to the transfer of a resident from the residential aged care facility to the emergency department: conflict with key stakeholders; knowledge and experience; policy and process; stakeholder perception; and recognition and support. CONCLUSIONS Robust outreach programs, support from other health-care professionals, and improving interdisciplinary understanding and communication between aged care nurses, paramedics and the emergency department would be advantageous to ensure effective care delivery and decision-making.
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Affiliation(s)
- Apil Gurung
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Marcoochydore, Queensland, Australia
| | - Michele Romeo
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Marcoochydore, Queensland, Australia
| | - Sean Clark
- Emergency Department at Caboolture Hospital, Metro-North Hospital and Health Services, Caboolture, Queensland, Australia
| | - Julia Hocking
- Office for Research, Griffith University, Nathan, Queensland, Australia
| | - Shannon Dhollande
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Marcoochydore, Queensland, Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Marcoochydore, Queensland, Australia
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15
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Seeger I, Günther U, Schmiemann G, Hoffmann F. [Care of older patients by community emergency paramedics : Comparison of community-dwellers and nursing home residents]. Med Klin Intensivmed Notfmed 2021; 117:542-548. [PMID: 34529128 PMCID: PMC9553795 DOI: 10.1007/s00063-021-00863-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Notaufnahmen und Rettungsdienste werden zunehmend durch nicht vital bedrohlich erkrankte Patienten belastet. Ein großer Anteil der Rettungsdiensteinsätze entfällt auf ältere Menschen. Um eine unnötige Disponierung höherwertiger Rettungsmittel zu reduzieren, wurde das Modellprojekt Gemeindenotfallsanitäter (G-NFS) entwickelt. Ziel der Arbeit Ziel dieser Arbeit war es herauszufinden, ob sich spezifische Einsatzschwerpunkte des G‑NFS in der Versorgung älterer Menschen in häuslicher Umgebung und im Pflegeheim zeigen. Material und Methoden Es handelt sich um eine retrospektive Beobachtungsstudie auf Basis der Einsatzdokumentation vom 01.07.2019 bis zum 30.06.2020. Es wurden G‑NFS Einsätze bei älteren Menschen (≥ 65 Jahre) analysiert, unterteilt nach den Einsatzorten Pflegeheim oder Häuslichkeit. Ergebnisse Es wurden 2358 Protokolle ausgewertet (Durchschnittsalter: 80,8 Jahre; 52,9 % weiblich). Vor Ort wurden 55 % der Patienten versorgt. Die durchgeführten Maßnahmen umfassten Beratungsgespräche (79,4 %), Hilfe bei Selbstmedikation (16,7 %) und Medikamentengabe (23,2 %). Auf Pflegeheimbewohner entfielen 329 (14,0 %) Einsätze. Maßnahmen in Bezug auf Urindauerkatheter wurden häufiger bei Pflegeheimbewohnern als in der Häuslichkeit durchgeführt (32,2 % bzw. 5,7 % aller Einsätze). Bei Patienten mit Katheterproblemen erfolgte im Vergleich zu anderen Einsätzen nahezu immer eine Versorgung vor Ort (84,3 % bzw. 52,2 %). Diskussion Durch G‑NFS können die Mehrzahl der älteren Patienten ambulant versorgt und andere Ressourcen entlastet werden. Allerdings führen G‑NFS auch Maßnahmen durch, die im Verantwortungsbereich der hausärztlichen Versorgung liegen, und gleichen somit strukturelle Defizite in der medizinisch-pflegerischen Versorgung aus. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00063-021-00863-8) enthält die Tabellen S1–S3.
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Affiliation(s)
- Insa Seeger
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Ulf Günther
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
- Universitätsklinik für Anästhesiologie | Intensivmedizin | Notfallmedizin | Schmerztherapie, Klinikum Oldenburg AöR, Oldenburg, Deutschland
| | - Guido Schmiemann
- Abteilung Versorgungsforschung, Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Bremen, Deutschland
- Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
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16
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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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17
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Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. METHODS This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). RESULTS 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21-3.30; OROFF 3.18, 95% CI 3.04-3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. CONCLUSIONS This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
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Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany.
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
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18
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Vom Pflegeheim ins Krankenhaus – Erfahrungen und potenzielle Maßnahmen zur Reduktion der Transporte aus Sicht von Rettungskräften. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00800-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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