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Uthuman A, Kim TH, Gu D. Understanding the Clinical Profile and Hospitalisation Patterns of Residents From Aged Care Facilities: A Regional Victorian Hospital Study. Cureus 2023; 15:e42694. [PMID: 37649940 PMCID: PMC10465186 DOI: 10.7759/cureus.42694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Residents of residential aged care facilities (RACFs) are typically frailer than their community-dwelling counterparts. They often present to the emergency department (ED) with varied health issues, frequently leading to hospital admissions. These admissions can exacerbate patient frailty and strain the healthcare system. Despite global efforts to reduce ED presentations from RACFs, effective strategies still need to be discovered. This study examines the clinical profile and hospitalisation patterns of RACF residents in a regional Victorian town. Aims The study aimed to assess the prevalence of ED presentations and representations from RACFs, investigate the causes and outcomes of hospital admissions stemming from these presentations, and evaluate the prevalence of documented (advanced care directives) ACDs within this patient cohort. Methods Following ethical approval, we conducted a retrospective analysis of 467 ED presentations from 310 RACF patients admitted to Goulburn Valley Health's (GVH) ED from January to June 2022. We collected and examined data on demographics, ACD existence, ED presentation characteristics, and hospital admissions, classifying admission reasons into eleven groups. Statistical analysis was performed with GraphPad Prism and IBM SPSS, using inferential tests and logistic regression to assess readmission odds at a significance threshold of p<0.05. Results Our study encompassed 310 patients from multiple RACFs, yielding 467 ED presentations. These constituted 2.28% of total ED visits and 9.85% of those aged 65 and above. Most of the cohort were females (59.4%), aged between 79 and 91. About 98 patients presented multiple times, and 48.2% of presentations led to hospital admissions, with 6.2% of admitted patients succumbing during the hospital stay. A documented ACD was absent in 42.9% of the cohort. Statistically significant results include a correlation between male sex and an increased frequency of ED representations (p=0.0422) and a longer ED stay duration for admitted patients (p<0.0001). No significant associations were found between ACD presence and ED representations, ACD and sex, or between age and duration of stay in the ED. Age did not differ significantly among patients with single or multiple presentations or between patients with or without ACD. Regarding fall-related presentations, no significant sex-based difference in admission rates was found. The duration of stay between surgical and medical admissions was also statistically indifferent. Conclusion Our study highlights the significant utilisation of ED services by RACF residents, mainly males. The substantial percentage of these presentations resulting in hospital admissions underlines the critical nature of these visits. The absence of ACD in a significant portion of the cohort and the lack of its influence on the frequency of representations signal the need for further exploration. The results underline the ongoing challenge of meeting the complex healthcare needs of RACF residents and emphasise the importance of gender-specific interventions and efficient hospital utilisation strategies to optimise healthcare delivery in this population. Future studies should further investigate the underlying reasons for these findings to inform targeted strategies for reducing unnecessary ED visits and hospital admissions. Furthermore, fall-related presentations necessitate comprehensive ED assessments and integrated management approaches.
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Affiliation(s)
- Ali Uthuman
- Department of Rural Health, University of Melbourne, Shepparton, AUS
- General Medicine, Goulburn Valley Health, Sehpparton, AUS
| | - Tae H Kim
- General Medicine, Goulburn Valley Health, Shepparton, AUS
| | - Dinglin Gu
- Internal Medicine, Western Health, Melbourne, AUS
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Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department. Microorganisms 2023; 11:microorganisms11020423. [PMID: 36838388 PMCID: PMC9966034 DOI: 10.3390/microorganisms11020423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Inappropriate use of the emergency department (IEDU)-consisting of the unnecessary use of the resource by patients with no clinical need-is one of the leading causes of the loss of efficiency of the health system. Specific contexts modify routine clinical practice and usage patterns. This study aims to analyse the influence of COVID-19 on the IEDU and its causes. Methods: A retrospective, cross-sectional study conducted in the emergency department of a high-complexity hospital. The Hospital Emergency Suitability Protocol (HESP) was used to measure the prevalence of IEDU and its causes, comparing three pairs of periods: (1) March 2019 and 2020; (2) June 2019 and 2020; and (3) September 2019 and 2020. A bivariate analysis and multivariate logistic regression models, adjusted for confounding variables, were utilized. Results: In total, 822 emergency visits were included (137 per period). A total prevalence of IEDU of 14.1% was found. There was a significant decrease in IEDU in March 2020 (OR: 0.03), with a prevalence of 0.8%. No differences were found in the other periods. A mistrust in primary care was the leading cause of IEDU (65.1%). Conclusions: The impact of COVID-19 reduced the frequency of IEDU during the period of more significant population restrictions, with IEDU returning to previous levels in subsequent months. Targeted actions in the field of population education and an improvement in primary care are positioned as strategies that could mitigate its impact.
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Long KM, Haines TP, Clifford S, Sundram S, Srikanth V, Macindoe R, Leung W, Hlavac J, Enticott J. English language proficiency and hospital admissions via the emergency department by aged care residents in Australia: A mixed-methods investigation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4006-e4019. [PMID: 35318761 PMCID: PMC10078708 DOI: 10.1111/hsc.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 11/25/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Residents of Residential Age Care Facilities (RACFs) have particularly high rates of Emergency Department (ED) visits, with up to 55% being potentially avoidable (e.g. not resulting in a hospital admission). This is concerning as ED visits by RACF residents are associated with negative outcomes including longer hospital stays, iatrogenic illness, complications and mortality. Limited English proficiency (LEP) has significant negative impacts on the healthcare quality and outcomes for older people but has not been studied as a factor in ED visits from RACFs. This study aimed to examine if RACF residents with LEP have a lower rate of hospital admission via the ED compared to non-LEP controls and identify any associated factors. We hypothesised that LEP-related communication difficulties would reduce the ability to manage minor health issues in the RACF, leading to a lower proportion of LEP ED transfers being admitted. We used a parallel mixed-methods design, comprising a quantitative matched cohort study of ED visit data from two Local Hospital Networks (LHNs) in South-East Melbourne, Australia and secondary thematic analysis of 25 interviews with LEP residents, family carers and staff from two RACFs in the same region. We found no differences in the proportion of hospital ED transfers that led to admission (LHN1, 87.1% LEP, 85.6% non-LEP controls, p = 0.57; LHN2, 76.0% LEP, 76.9% non-LEP controls, p = 0.41) and no direct qualitative evidence suggesting that resident LEP affected decisions to transfer residents to ED, despite communication difficulties being reported during the transfer process. These results may be due to the high level of family carer involvement in residents' care identified in the qualitative study. However, additional research using different measures of LEP is recommended to further explore a broader range of cultural and linguistic factors in both rates of ED presentations and the decision-making processes underpinning resident transfers to ED.
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Affiliation(s)
- Katrina M. Long
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia
| | - Terry P. Haines
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia
| | - Sharon Clifford
- Department of General PracticeSchool of Public Health and Preventive MedicineMonash UniversityNotting HillVictoriaAustralia
| | - Suresh Sundram
- Department of PsychiatrySchool of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
- Mental Health ProgramMonash HealthClaytonVictoriaAustralia
| | - Velandai Srikanth
- Peninsula HealthFrankstonVictoriaAustralia
- Peninsula Clinical SchoolCentral Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingFrankstonVictoriaAustralia
| | - Rob Macindoe
- SEHCP Inc. (t/a enliven)DandenongVictoriaAustralia
| | - Wing‐Yin Leung
- Department of Psychological SciencesSchool of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Jim Hlavac
- Translation and Interpreting StudiesSchool of Languages, Literatures, Cultures and LinguisticsMonash UniversityClaytonVictoriaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and ImplementationClaytonVictoriaAustralia
- Southern SynergyDepartment of PsychiatrySchool of Clinical Sciences, Monash UniversityClaytonVictoriaAustralia
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Zúñiga F, Gaertner K, Weber-Schuh SK, Löw B, Simon M, Müller M. Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review. BMC Geriatr 2022; 22:659. [PMID: 35948872 PMCID: PMC9367060 DOI: 10.1186/s12877-022-03308-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Emergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital. Methods This is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (≥ 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits—measured as ambulatory-care sensitive conditions (ACSCs)—were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis. Results Six percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p≤0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p≤0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p≤0.001) and laboratory resource use (334 tax points vs. 214, p≤0.001) were higher for potentially-avoidable ED visits. Conclusions We revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings’ public health implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03308-9.
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Affiliation(s)
- Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Katharina Gaertner
- Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | - Sabine K Weber-Schuh
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,GP practice, Praxis Weissenbühl, Bern, Switzerland
| | - Barbara Löw
- Department of Practice Development in Nursing, Solothurner Spitaler AG, Solothurn, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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Dai J, Liu F, Irwanto D, Kumar M, Tiwari N, Chen J, Xu Y, Smith M, Chan DKY. Impact of an acute geriatric outreach service to residential aged care facilities on hospital admissions. Aging Med (Milton) 2021; 4:169-174. [PMID: 34553113 PMCID: PMC8444962 DOI: 10.1002/agm2.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Residential aged care facility (RACF) residents frequently present to the emergency department (ED) and are often admitted to hospital. Some presentations and admissions may be avoidable. In 2013, Bankstown-Lidcombe Hospital introduced a subacute geriatric outreach service (SGOS), which had little impact on reducing ED presentations. In 2015, Bankstown-Lidcombe Hospital introduced an acute geriatric outreach service (AGOS), a geriatrician-led team that assesses and treats acutely unwell patients in RACFs. We aim to determine whether the AGOS reduces the risk of hospital admission for RACF residents. METHODS Hospital admissions data from 2010 to 2019 were used to conduct an interrupted time series (ITS) analysis. AGOS activity data were also summarized. RESULTS The average number of admissions from RACF per month declined from 42.8 during the SGOS period to 27.1 during the AGOS period. The difference of 15.7 admissions from RACF per month was statistically significant (95% CI 12.1-19.2; P < .001). After the introduction of the AGOS, the risk of admission to our geriatric department from RACFs was reduced by 36.1% (incidence rate ratio =0.64; 95% CI: 0.58-0.71; P < .001) compared to the SGOS period, adjusting for seasonality. DISCUSSION The AGOS probably reduced the risk of hospital admission for RACF residents.
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Affiliation(s)
- Jun Dai
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Frank Liu
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Deni Irwanto
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Manoj Kumar
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Nabaraj Tiwari
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Jack Chen
- Ingham Institute & Simpson Centre for Health Services ResearchSWS Clinical School/UNSWSydneyNSWAustralia
| | - Yinghua Xu
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
- Ingham Institute & Simpson Centre for Health Services ResearchSWS Clinical School/UNSWSydneyNSWAustralia
| | - Matthew Smith
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Daniel KY Chan
- Aged Care and Rehabilitation DepartmentBankstown‐Lidcombe HospitalBankstownNSWAustralia
- Ingham Institute & Simpson Centre for Health Services ResearchSWS Clinical School/UNSWSydneyNSWAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNSWAustralia
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Caughey GE, Jorissen RN, Lang C, Wesselingh SL, Inacio MC. Hospitalisation for lower respiratory viral infections in older people in residential aged care facilities. Australas J Ageing 2021; 41:e58-e66. [PMID: 34192408 DOI: 10.1111/ajag.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To quantify incidence, trends and outcomes associated with lower respiratory viral infection (LRVI) hospitalisations in Australian residential aged care facilities (RACFs). METHODS A population-based cohort study of residents in RACFs aged ≥65 years from New South Wales (NSW), South Australia (SA) and Victoria (VIC) using data from the Registry of Senior Australians (2013-2016) was conducted. Age- and sex-standardised monthly and yearly LRVI hospitalisation incidences were calculated, and time trends and risk factors were assessed. RESULTS Of 268 657 residents included over the study period, 12% had ≥1 LRVI hospitalisation. Average annual incidence/1000 residents was 7.1 [6.9-7.2] in 2013, increasing to 7.8 [7.7-8.1] in 2016. Males, increasing co-morbidity, presence of CHF, respiratory disease and hypertension had a higher incidence of LRVI hospitalisation. In-hospital mortality was 14%. Within 30 days following discharge, 15% died and 8% were readmitted. CONCLUSION Prior to COVID-19, incidence of hospitalisation for LRVI in Australia's residential aged care population was increasing and was associated with significant morbidity and mortality.
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Affiliation(s)
- Gillian E Caughey
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.,Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Robert N Jorissen
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Department of Rehabilitation, Aged and Extended Care, Flinders University, Bedford Park, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Steve L Wesselingh
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Flicker L. Why is it so hard to organise healthcare for older people in residential aged care facilities in Australia? Intern Med J 2021; 51:11-12. [PMID: 33572026 DOI: 10.1111/imj.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Leon Flicker
- Medical School, University of Western Australia, and Royal Perth Hospital, Perth, Western Australia, Australia
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8
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Chua TH, Foong JRJ, Tan RR, Rukasha PN, Hullick C. Assessment of advance care planning documentation for residents of residential aged care facilities presenting to the emergency department. AUST HEALTH REV 2020; 44:847-852. [PMID: 33213690 DOI: 10.1071/ah19238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022]
Abstract
Objective This study assessed the availability and quality of advance care planning (ACP) documentation among older residential aged care facility (RACF) residents who presented to the emergency department (ED). Methods A prospective review of the medical records of RACF residents aged ≥75 years who presented to the ED from May to June 2018 was conducted. Availability of ACP was determined based on the presence of an ACP document inclusive of an advance care directive (ACD) in the medical record. The quality of ACP documentation was determined based on the presence of nine key components. Results In all, 48.8% of patients presented to the ED with either ACP or an ACD. However, only a mean total of 3.8 (out of 9) ACP components were documented in these documents. Conclusions Just under half (48.8%) of RACF residents presented to the ED with ACP documentation. There was limited coverage of core ACP components needed to guide clinical decision making. What is known about the topic? RACF residents are in the last years of their life and commonly lack capacity to make decisions regarding health care. Residents are at high risk of dying when acutely unwell in hospital. ACP documentation, when readily available, helps provide appropriate end-of-life care and improves both patient and family satisfaction. What does this paper add? Less than half the residents reporting to the ED from an RACF had ACP documentation available for clinicians. For those who presented to the ED with ACP documentation, most lacked sufficient information needed to provide care in full accordance with the patient's preferences. What are the implications for practitioners? There is a need to encourage, initiate, actively engage and develop systems for ACP conversations, documentation and availability when acutely unwell for people living in RACFs to provide sufficient information to guide clinical decision making. Without quality ACP, the provision of patient-centred health care may be compromised.
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Affiliation(s)
- Tzy Harn Chua
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Jessica Ru-Jia Foong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Ryan Renxin Tan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Princess Natsai Rukasha
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Carolyn Hullick
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ; ; and Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; and Belmont Hospital, Croudace Bay Road, Belmont, NSW 2280, Australia; and Corresponding author.
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Eastwood K, Nambiar D, Dwyer R, Lowthian JA, Cameron P, Smith K. Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study. BMJ Open 2020; 10:e042351. [PMID: 33158837 PMCID: PMC7651717 DOI: 10.1136/bmjopen-2020-042351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches. OBJECTIVES To examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch. DESIGN A retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted. SETTING The secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period. PARTICIPANTS There were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses. MAIN OUTCOME MEASURES Descriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients. RESULTS The dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005). CONCLUSION Secondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Dhanya Nambiar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosamond Dwyer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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Sluggett JK, Lalic S, Hosking SM, Ilomӓki J, Shortt T, McLoughlin J, Yu S, Cooper T, Robson L, Van Dyk E, Visvanathan R, Bell JS. Root cause analysis of fall-related hospitalisations among residents of aged care services. Aging Clin Exp Res 2020; 32:1947-1957. [PMID: 31728845 DOI: 10.1007/s40520-019-01407-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fall-related hospitalisations from residential aged care services (RACS) are distressing for residents and costly to the healthcare system. Strategies to limit hospitalisations include preventing injurious falls and avoiding hospital transfers when falls occur. AIMS To undertake a root cause analysis (RCA) of fall-related hospitalisations from RACS and identify opportunities for fall prevention and hospital avoidance. METHODS An aggregated RCA of 47 consecutive fall-related hospitalisations for 40 residents over a 12-month period at six South Australian RACS was undertaken. Comprehensive data were extracted from RACS records including nursing progress notes, medical records, medication charts, hospital summaries and incident reports by a nurse clinical auditor and clinical pharmacist. Root cause identification was performed by the research team. A multidisciplinary expert panel recommended strategies for falls prevention and hospital avoidance. RESULTS Overall, 55.3% of fall-related hospitalisations were among residents with a history of falls. Among all fall-related hospitalisations, at least one high falls risk medication was administered regularly prior to hospitalisation. Potential root causes of falling included medication initiations and dose changes. Root causes for hospital transfers included need for timely access to subsidised medical services or radiology. Strategies identified for avoiding hospitalisations included pharmacy-generated alerts when medications associated with an increased risk of falls are initiated or changed, multidisciplinary audit and feedback of falls risk medication use and access to subsidised mobile imaging services. CONCLUSIONS This aggregate RCA identified a range of strategies to address resident and system-level factors to minimise fall-related hospitalisations.
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Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia.
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Sarah M Hosking
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
| | - Jenni Ilomӓki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Solomon Yu
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, SA, Australia
| | | | - Eleanor Van Dyk
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
| | - Renuka Visvanathan
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, National Health and Medical Research Council of Australia, Adelaide, SA, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Kwa JM, Storer M, Ma R, Yates P. Integration of Inpatient and Residential Care In-Reach Service Model and Hospital Resource Utilization: A Retrospective Audit. J Am Med Dir Assoc 2020; 22:670-675. [PMID: 32928658 PMCID: PMC7486062 DOI: 10.1016/j.jamda.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In parts of Australia, Residential In-Reach (RIR) services have been implemented to treat residential aged care (RAC) residents for acute conditions in their place of residence to avoid preventable hospital presentation. Our service was initiated in 2009 and restructured in 2014. We compared acute healthcare resource utilization (RIR activity and emergency hospital presentations) by RAC residents under 2 RIR models of care. DESIGN Acute RAC RIR service model of care was changed from existing nurse/emergency physician-led service to nurse/geriatrician-led service and incorporate inpatient liaison nurse consultant into the team. SETTING RAC episodes and hospital presentations from a single tertiary referral hospital and its associated RAC RIR service. METHODS Retrospective audit comparing RIR activity, hospital presentations, and associated costs from 2 12-month periods, prior to and postimplementation. Data were expressed as a proportion of the total number of RAC beds in the hospital RIR catchment. RESULTS After implementation of the new model of care, RIR episodes of care increased from 589 to 985 (15.3 vs 24.7 episodes/100 RAC beds, P < .001). Emergency department (ED) presentations fell from 1616 to 1478 (41.9 vs 37.2 presentations/100 RAC beds, P < .001). There were fewer unplanned ED presentations by RIR patients (2.4% vs 0.8%, = 0.03) and fewer 28-day ED re-presentations (16.8% vs 13.7%, P = .01) under the new model of care. ED cost [$AUD 30,830 vs $28,030/100 RAC beds ($USD 21,344 vs $19,407), P < .001] and inpatient admission costs [$145,607 vs $117,531/100 RAC beds ($USD 100,814 vs $81,380), P < .001] were each lower in the second period. CONCLUSIONS AND IMPLICATIONS In the 12 months following implementation of the new model of care, an increase in RIR activity, and a decrease in ED presentations was observed. Further research is necessary to validate these retrospective findings and better evaluate clinical outcomes and consumer satisfaction of the service.
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Affiliation(s)
- Jie-Min Kwa
- Department of Geriatric Medicine, Austin Health, Studley Road, Heidelberg, VIC, Australia
| | - Meg Storer
- Department of Geriatric Medicine, Austin Health, Studley Road, Heidelberg, VIC, Australia
| | - Ronald Ma
- Department of Finance, Austin Health, Studley Road, Heidelberg, VIC, Australia
| | - Paul Yates
- Department of Geriatric Medicine, Austin Health, Studley Road, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia.
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12
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El-Masri M, Bornais J, Omar A, Crawley J. Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. J Emerg Nurs 2020; 46:478-487. [DOI: 10.1016/j.jen.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
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13
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Sluggett JK, Lalic S, Hosking SM, Ritchie B, McLoughlin J, Shortt T, Robson L, Cooper T, Cairns KA, Ilomäki J, Visvanathan R, Bell JS. Root Cause Analysis to Identify Medication and Non-Medication Strategies to Prevent Infection-Related Hospitalizations from Australian Residential Aged Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093282. [PMID: 32397193 PMCID: PMC7246482 DOI: 10.3390/ijerph17093282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infection, and models of care that facilitate timely access to medical services. The RCA and clinical panel findings provide a roadmap to assist targeting services to prevent infection and limit unnecessary hospital transfers from RACS.
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Affiliation(s)
- Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (S.L.); (S.M.H.); (J.I.); (J.S.B.)
- University of South Australia, Adelaide 5001, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby 2077, Australia
- Correspondence: ; Tel.: +61-8812-849-99
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (S.L.); (S.M.H.); (J.I.); (J.S.B.)
- Pharmacy Department, Monash Health, Melbourne 3168, Australia
| | - Sarah M. Hosking
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (S.L.); (S.M.H.); (J.I.); (J.S.B.)
- National Health and Medical Research Council of Australia Centre of Research Excellence in Frailty and Healthy Aging, Adelaide 5005, Australia;
| | - Brett Ritchie
- Infectious Diseases Department, Women’s and Children’s Hospital, Adelaide 5006, Australia;
| | - Jennifer McLoughlin
- Resthaven Incorporated, Adelaide 5034, Australia; (J.M.); (T.S.); (L.R.); (T.C.)
| | - Terry Shortt
- Resthaven Incorporated, Adelaide 5034, Australia; (J.M.); (T.S.); (L.R.); (T.C.)
| | - Leonie Robson
- Resthaven Incorporated, Adelaide 5034, Australia; (J.M.); (T.S.); (L.R.); (T.C.)
| | - Tina Cooper
- Resthaven Incorporated, Adelaide 5034, Australia; (J.M.); (T.S.); (L.R.); (T.C.)
| | - Kelly A. Cairns
- Pharmacy Department, The Alfred, Alfred Health, Melbourne, VIC 3181, Australia;
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (S.L.); (S.M.H.); (J.I.); (J.S.B.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council of Australia Centre of Research Excellence in Frailty and Healthy Aging, Adelaide 5005, Australia;
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide 5011, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (S.L.); (S.M.H.); (J.I.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby 2077, Australia
- National Health and Medical Research Council of Australia Centre of Research Excellence in Frailty and Healthy Aging, Adelaide 5005, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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14
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Gurung A, Broadbent M, Bakon S, Hocking J, Glenwright A, Shaw C, Tweddell S, Clark S. Understanding registered nurse decision-making, communication and care delivery between emergency departments and residential aged care facilities: A research protocol. Australas J Ageing 2019; 39:277-282. [PMID: 31782254 DOI: 10.1111/ajag.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision-making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. METHODS The proposed mixed-method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. RESULTS The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs.
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Affiliation(s)
- Apil Gurung
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Shannon Bakon
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Julia Hocking
- Griffith University, Brisbane, Queensland, Australia
| | - Amanda Glenwright
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Christine Shaw
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sheryl Tweddell
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sean Clark
- Emergency Department, Caboolture Hospital, Caboolture, Queensland, Australia
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15
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Naouri D, Ranchon G, Vuagnat A, Schmidt J, El Khoury C, Yordanov Y. Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France. BMJ Qual Saf 2019; 29:449-464. [PMID: 31666304 PMCID: PMC7323738 DOI: 10.1136/bmjqs-2019-009396] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/03/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France. METHOD The French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs. RESULTS Among the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density. CONCLUSION Inappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.
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Affiliation(s)
- Diane Naouri
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | | | - Albert Vuagnat
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
| | - Jeannot Schmidt
- Emergency Department, Clermont-Ferrand University Hospital, Clermont Ferrand, France
- EA 4679, Université Clermont Auvergne, Clermont Ferrand, France
| | - Carlos El Khoury
- Emergency Department, Médipôle, Villeurbanne, France
- RESCUe-RESUVal, INSERM, HESPER EA 7425, Lyon, France
| | - Youri Yordanov
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
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16
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Ní Chróinín D, Goldsbury DE, Beveridge A, Davidson PM, Girgis A, Ingham N, Phillips JL, Wilkinson AM, Ingham JM, O'Connell DL. Health-services utilisation amongst older persons during the last year of life: a population-based study. BMC Geriatr 2018; 18:317. [PMID: 30572832 PMCID: PMC6302397 DOI: 10.1186/s12877-018-1006-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/05/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia. METHODS Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Several measures of hospital-based service utilisation during the last year of life were assessed from retrospectively linked data comprising data for all registered deaths, cause of death, hospital care during the last year of life (NSW Admitted Patient Data Collection [APDC] and Emergency Department [ED] Data Collection [EDDC]), and the NSW Cancer Registry. RESULTS Amongst 34,556 decedents aged ≥70 years, 82% (n = 28,366) had ≥1 hospitalisation during the last year of life (median 2), and 21% > 3 hospitalisations. Twenty-five percent (n = 5485) of decedents attended ED during the last week of life. Overall, 21% had a hospitalisation > 30 days in the last year of life, and 7% spent > 3 months in hospital; 79% had ≥1 ED attendance, 17% > 3. Nine percent (n = 3239) spent time in an intensive care unit. Fifty-three percent (n = 18,437) died in an inpatient setting. Hospital records had referenced palliative care for a fifth (7169) of decedents. Adjusting for age group, sex, place of residence, area-level socioeconomic status, and cause of death, having > 3 hospitalisations during the last year of life was more likely for persons dying from cancer (35% versus 16% non-cancer deaths, adjusted odds ratio [aOR] 2.33), 'younger' old decedents (29% for age 70-79 and 20% for age 80-89 versus 11% for 90+, aOR 2.42 and 1.77 respectively) and males (25% versus 17% females, aOR 1.38). Patterns observed for other hospital-based service use were similar. CONCLUSIONS This population-based study reveals high use of hospital care among older persons during their last year of life, although this decreased with increasing older age, providing important data to inform health services planning for this population, and highlighting aspects requiring further study.
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Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, UNSW, Corner of Elizabeth and Goulburn Streets, Liverpool, Sydney, NSW, 2170, Australia.
| | | | - Alexander Beveridge
- Department of Geriatric Medicine, St. Vincent's Hospital, and St Vincent's Clinical School, UNSW, Sydney, Australia
| | - Patricia M Davidson
- Faculty of Health, University of Technology Sydney, New South Wales, Australia and Johns Hopkins University, Baltimore, MD, USA
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Australia, Sydney, Australia
| | - Nicholas Ingham
- Department of Geriatric Medicine, St. Vincent's Hospital, and UNSW Australia, St Vincent's Clinical School, Faculty of Medicine, Sydney, Australia
| | - Jane L Phillips
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Anne M Wilkinson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Jane M Ingham
- UNSW Sydney, Faculty of Medicine, St Vincent's Clinical School Darlinghurst, Sydney, Australia
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17
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Laging B, Kenny A, Bauer M, Nay R. Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography. J Clin Nurs 2018; 27:1452-1463. [PMID: 29396884 DOI: 10.1111/jocn.14292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the recognition and assessment of resident deterioration in the nursing home setting. BACKGROUND There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident. DESIGN Critical ethnography. METHODS Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers. CONCLUSIONS Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.
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Affiliation(s)
- Bridget Laging
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia
| | - Amanda Kenny
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Rhonda Nay
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
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18
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Amadoru S, Rayner JA, Joseph R, Yates P. Factors influencing decision-making processes for unwell residents in residential aged care: Hospital transfer or Residential InReach referral? Australas J Ageing 2018; 37:E61-E67. [PMID: 29476607 DOI: 10.1111/ajag.12512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate decision-making around hospital transfer and/or referral of residents to a Residential InReach (RiR) service in north-eastern metropolitan Melbourne, Australia, from the perspectives of residential aged care facility (RACF) staff, general practitioners (GPs) and RiR registered nurses (RNs). METHODS Thirty-one staff from eight RACFs, five GPs and four RiR RNs participated in individual or group interviews. RESULTS Residential aged care facility staff and GPs valued and relied upon RiR to manage unwell residents. Thematic analysis identified RiR utilisation was driven by the following: (i) complexity of decision-making processes in RACFs; (ii) variability in facility-based medical and nursing care; and (iii) impact of RiR service outcomes on patients and referrers. CONCLUSION Availability of timely and appropriate medical and nursing care in RACFs was reported to influence transfers to the hospital and/or referrals to RiR. RiR was used to complement or substitute usual care available to residents. Further research and improvements in RACF and RiR resources are required.
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Affiliation(s)
- Sanka Amadoru
- Department of Geriatric Medicine (Aged and Continuing Care), Austin Health, Melbourne, Victoria, Australia.,Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Jo-Anne Rayner
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia
| | - Rajni Joseph
- Department of Geriatric Medicine (Aged and Continuing Care), Austin Health, Melbourne, Victoria, Australia.,Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Paul Yates
- Department of Geriatric Medicine (Aged and Continuing Care), Austin Health, Melbourne, Victoria, Australia.,Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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19
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O'Neill BJ, Dwyer T, Reid-Searl K, Parkinson L. Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour. J Clin Nurs 2018; 27:e992-e1003. [DOI: 10.1111/jocn.14119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara J. O'Neill
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Kerry Reid-Searl
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Lynne Parkinson
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
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20
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21
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Tsai HH, Tsai YF. Development, validation and testing of a nursing home to emergency room transfer checklist. J Clin Nurs 2017; 27:115-122. [PMID: 28401615 DOI: 10.1111/jocn.13853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 12/23/2022]
Abstract
AIMS AND OBJECTIVES To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. BACKGROUND Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. DESIGN Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. METHODS Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. RESULTS Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. CONCLUSIONS The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. RELEVANCE TO CLINICAL PRACTICE Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals.
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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22
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Perrin A, Tavassoli N, Mathieu C, Hermabessière S, Houles M, McCambridge C, Magre E, Fernandez S, Caquelard A, Charpentier S, Lauque D, Azema O, Bismuth S, Chicoulaa B, Oustric S, Costa N, Molinier L, Vellas B, Bérard E, Rolland Y. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun 2017; 7:217-223. [PMID: 29696189 PMCID: PMC5898573 DOI: 10.1016/j.conctc.2017.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents) is determined by a multidisciplinary team of experts. Results Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.
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Affiliation(s)
- Amélie Perrin
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Corresponding author. La Cité de la Santé - Équipe Régionale Vieillissement et Prévention de la Dépendance, 20 rue du Pont Saint Pierre – TSA 60033, 31059, Toulouse Cedex 9, France.
| | - Céline Mathieu
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Observatoire Régional de La Santé de Midi-Pyrénées (ORSMIP), Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Cécile McCambridge
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Elodie Magre
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sophie Fernandez
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Caquelard
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sandrine Charpentier
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Dominique Lauque
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UFR Sciences Médicales, Université de Toulouse III, Toulouse, France
| | - Olivier Azema
- Observatoire Régional des Urgences de Midi-Pyrénées (ORU-MiP), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Bismuth
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Stéphane Oustric
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Nadège Costa
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Molinier
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Département D’Epidémiologie, D’Economie de La Santé et de Santé Publique, Université Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Emilie Bérard
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Service D'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
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Marsden E, Taylor A, Wallis M, Craswell A, Broadbent M, Barnett A, Nguyen KH, Crilly J, Johnston C, Glenwright A. A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol. BMC Geriatr 2017; 17:76. [PMID: 28330452 PMCID: PMC5363028 DOI: 10.1186/s12877-017-0462-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/10/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed. The aim of this Geriatric Emergency Department Intervention is to maximise the quality of care for this vulnerable cohort in a cost effective manner. METHODS The Geriatric Emergency Department Intervention research project consists of three interrelated studies within a program evaluation design. The research comprises of a structure, process and outcome framework to ascertain the overall utility of such a program. The first study is a pre-post comparison of the Geriatric Emergency Department Intervention in the emergency department, comparing the patient-level outcomes before and after service introduction using a quasi-experimental design with historical controls. The second study is a descriptive qualitative study of the structures and processes required for the operation of the Geriatric Emergency Department Intervention and clinician and patient satisfaction with service models. The third study is an economic evaluation of the Geriatric Emergency Department Intervention model of care. DISCUSSION There is a paucity of evidence in the literature to support the implementation of nurse-led teams in emergency departments designed to target frail older persons living in the community and residential aged care facilities. This is despite the high economic and patient morbidity and mortality experienced in these vulnerable cohorts. This research project will provide guidance related to the optimal structures and processes required to implement the model of care and the associated cost related outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registration Number is 12615001157561 . Date of registration 29 October 2015.
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Affiliation(s)
- Elizabeth Marsden
- Nambour Emergency Department, Sunshine Coast and Hospital Health Service, Hospital Rd, Nambour, QLD 4560 Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Andrea Taylor
- Nambour Emergency Department, Sunshine Coast and Hospital Health Service, Hospital Rd, Nambour, QLD 4560 Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Marc Broadbent
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Adrian Barnett
- Queensland University of Technology, Brisbane, QLD 4059 Australia
| | - Kim-Huong Nguyen
- Center for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Logan, Australia
| | - Julia Crilly
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Parkwood, QLD 4215 Australia
- Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215 Australia
| | - Colleen Johnston
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Amanda Glenwright
- Central Queensland, Wide Bay, Sunshine Coast PHN, Ground Floor, Mayfield House, 29 The Esplanade, Maroochydore, QLD 4558 Australia
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Abstract
OBJECTIVES Nursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences. DESIGN A systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed. SETTING Studies conducted in nursing homes were included. PARTICIPANTS Nursing home residents. PRIMARY AND SECONDARY OUTCOMES Outcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex. RESULTS We identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80-85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses. DISCUSSION Male NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.
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Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Lukin B, Fan LJ, Zhao JZ, Sun JD, Dingle K, Purtill R, Tapp S, Hou XY. Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia. World J Emerg Med 2016; 7:183-90. [PMID: 27547277 DOI: 10.5847/wjem.j.1920-8642.2016.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007]. CONCLUSION The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.
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Affiliation(s)
- Bill Lukin
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia
| | - Li-Jun Fan
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia
| | - Jing-Zhou Zhao
- Bureau of Investment Promotion, Wuwei City 733000, Gansu Province, China
| | - Jian-Dong Sun
- Queensland Health, Brisbane, Queensland 4029, Australia
| | - Kaeleen Dingle
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia
| | - Rhonda Purtill
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia
| | - Sam Tapp
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia
| | - Xiang-Yu Hou
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia
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Davis J, Morgans A, Burgess S. Information management in the Australian aged care setting. HEALTH INF MANAG J 2016; 46:3-14. [DOI: 10.1177/1833358316639434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting. Objective: To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management. Methods: An integrative review of Australian literature published between March 2008 and August 2014 and data collection frameworks concerning information management in aged care were carried out. Results: There is limited research investigating the information-rich setting of aged care in Australia. Electronic systems featured strongly in the review. Existing research focuses on residential settings with community aged care largely absent. Information systems and processes in the setting of aged care in Australia are underdeveloped and poorly integrated. Conclusions: Data quality and access are more problematic within community aged care than residential care settings. The results of this review represent an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care.
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Affiliation(s)
- Jenny Davis
- Benetas, Victoria, Australia
- Monash University, Australia
| | - Amee Morgans
- Monash University, Australia
- Royal District Nursing Service, Victoria, Australia
| | - Stephen Burgess
- Benetas, Victoria, Australia
- Monash University, Australia
- Royal District Nursing Service, Victoria, Australia
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Montalto M, Shay S, Le A. Evaluation of a mobile X-ray service for elderly residents of residential aged care facilities. AUST HEALTH REV 2016; 39:517-521. [PMID: 26072938 DOI: 10.1071/ah15059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Royal Melbourne Hospital established a mobile X-ray service (MXS) in 2013. The goal of the MXS is to address the radiology needs of frail, elderly or demented residents of residential aged care facilities (RACFs) who would otherwise require transportation to attend for X-ray. The present study describes the activity of the MXS, and the impact of the MXS on emergency department (ED) attendances by residents of RACFs. METHODS The study is a descriptive study and uses a before-and-after cohort approach. Activity for the first year of operation was collected and described. At the end of the first year of operation, the top 30 RACF users of the MXS were identified. The hospital Department of Radiology database was examined to find all plain X-rays performed on any patient presenting from the same 30 RACFs for the 1 year before commencement of the MXS (1 July 2012-30 June 2013) and for the 1 year period after the commencement of the MXS (1 July 2013-30 June 2014). Attendances were compared. RESULTS The MXS delivered 1532 service attendances to 109 different RACFs. The mean age of patients receiving MXS services was 86 years (range 16-107 years). In all, 1124 services (73.4%) were delivered to patients in high-care RACFs. Most patients (n = 634; 41.4%) were bed or wheelchair bound, followed by those who required assistance to ambulate (n = 457; 29.8%). The most common X-ray examinations performed were chest, hip and pelvis, spine and abdomen. There were 919 service attendances to the top 30 RACFs using the MXS (60.0% of all attendances). There was an 11.5% reduction in ED presentations requiring plain X-ray in the year following the commencement of the MXS (95% confidence interval 0.62-3.98; P = 0.019). CONCLUSION The present study suggests a reduction in hospital ED attendances for high users of the MXS. This has benefits for hospitals, patients and nursing homes. It also allows the extension of other programs designed to treat patients in their RACFs. Special rebates for home-based radiology service provision should be considered.
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Affiliation(s)
- Michael Montalto
- Hospital in the Home, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050, Australia
| | - Simon Shay
- Aged Care Imaging, 63A Clyde Street, Thornbury, Vic. 3071, Australia. Email
| | - Andy Le
- Department of Radiology, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050, Australia. Email
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Montalto M, Chu MY, Ratnam I, Spelman T, Thursky K. The treatment of nursing home-acquired pneumonia using a medically intensive Hospital in the Home service. Med J Aust 2016; 203:441-2. [PMID: 26654613 DOI: 10.5694/mja15.00672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the outcomes for patients with nursing home-acquired pneumonia (NHAP) treated completely in a Hospital in the Home (HITH) setting with those of patients treated in a traditional hospital ward. DESIGN Case-control study. SETTING AND PARTICIPANTS All patients admitted by the Royal Melbourne Hospital for treatment of NHAP from 1 July 2013 to 31 January 2014. INTERVENTION Admission to the Royal Melbourne Hospital HITH Unit within 48 hours of presentation. MAIN OUTCOME MEASURES Length of stay, in-hospital and 30-day mortality, hospital readmissions (30-day), complications and unplanned returns to hospital. RESULTS Sixty HITH patients and 54 hospital (control) patients were identified. Thirty-two patients (53%) were admitted directly to HITH without any hospital or emergency stay, 25 (42%) were referred directly from the emergency department. HITH patients were more likely to be male, older and dehydrated, and less likely to have an advanced care directive or to have had non-invasive ventilation. There were no significant differences in CURB-65 or CORB scores between the two patient groups; similar proportions were given intravenous fluids or supplemental oxygen. There were no adjusted differences in median length of stay between HITH and control patients (-1.00 days; 95% CI, -2.72 to 0.72; P = 0.252) or in overall mortality at 30 days (HITH v control patients: adjusted odds ratio [aOR], 1.97; 95% CI, 0.67-5.73). Inpatient mortality was lower for HITH patients (aOR, 0.19; 95% CI, 0.05-0.75) but unadjusted postdischarge 30-day mortality was higher (OR, 13.25; 95% CI 1.67-105.75). There were no differences between the two groups with regard to complications (falls and pressure wounds) and 30-day readmission rates (aOR, 1.59; 95% CI, 0.30-8.53). CONCLUSIONS This study suggests that HITH may be an effective and safe alternative to hospital treatment for residents of aged care facilities presenting with NHAP.
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Affiliation(s)
| | | | - Irani Ratnam
- Victorian Infectious Diseases Service, Melbourne, VIC
| | - Tim Spelman
- Victorian Infectious Diseases Service, Melbourne, VIC
| | - Karin Thursky
- NHMRC National Centre for Antimicrobial Stewardship and Guidance, Doherty Institute for Infection and Immunity, Melbourne, VIC
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29
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Tsai HH, Tsai YF, Huang HL. Nursing home nurses’ experiences of resident transfers to the emergency department: no empathy for our work environment difficulties. J Clin Nurs 2016; 25:610-8. [DOI: 10.1111/jocn.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Yun-Fang Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
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30
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Fan L, Hou XY, Zhao J, Sun J, Dingle K, Purtill R, Tapp S, Lukin B. Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study. BMC Health Serv Res 2016; 16:46. [PMID: 26857447 PMCID: PMC4746777 DOI: 10.1186/s12913-016-1275-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). METHODS A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. RESULTS Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67-0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50-0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43-0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65-0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54-0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61-1.11); p = 0.196). CONCLUSIONS Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.
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Affiliation(s)
- Lijun Fan
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Xiang-Yu Hou
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Jingzhou Zhao
- Bureau of Investment Promotion, Wuwei City, 733000, Gansu Province, P. R. China.
| | - Jiandong Sun
- Queensland Health, Brisbane, QLD, 4029, Australia.
| | - Kaeleen Dingle
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Rhonda Purtill
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
| | - Sam Tapp
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
| | - Bill Lukin
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
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31
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Hillen JB, Vitry A, Caughey GE. Trends in general practitioner services to residents in aged care. Aust J Prim Health 2016; 22:517-522. [DOI: 10.1071/py15119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
To date, access to appropriate and timely GP services for those in aged care has been described as limited, in part due to inadequate models of care and remuneration. As the Australian population ages and more Australians become dependent on aged-care services, the need for good quality medical care that meets the needs of residents will continue to grow. The purpose of this study was to provide a current analysis of trends in GP services in residents in Australian aged-care facilities. Longitudinal population data (2005–2014) was used to describe the changing population demographics and calculate annual rates for GP services specific to this population. Total population and age-group strata (<85 years and 85+ years) rates were calculated for standard consultations, after-hours consultations, contribution to a care plan and collaborative medication review. For the period 2005–2014 there was an increase of 1.5 million GP services to this population, which had simultaneously grown by 19800 residents, aged (6% increase in residents aged 85+ years) and become more dependent (14% increase is high-care residents). Significant increases in all GP service rates were observed, with a shift towards after-hours consultations. Residents aged <85 years received significantly more services than residents aged 85+ years. GP service delivery to the whole aged-care population continues to be heavily weighted towards standard and after-hours consultations, while collaborative GP services remain a very small proportion of services accessed by this population. There is scope to increase collaborative GP services, which have been linked to improved outcomes for this population.
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32
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Chang SC, Shiu MN, Chen HT, Ng YY, Lin LC, Wu SC. Evaluation of care quality for disabled older patients living at home and in institutions. J Clin Nurs 2015; 24:3469-80. [DOI: 10.1111/jocn.12946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Huey-Tzy Chen
- Department of Nursing; Fu Jen Catholic University; Taipei Taiwan
| | - Yee-Yung Ng
- Division of Nephrology; Department of Medicine; Veterans General Hospital-Taipei; Taipei Taiwan
| | - Li-Chan Lin
- Institute of Clinical and Community Health Nursing; National Yang-Ming University; Taipei Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy; National Yang-Ming University; Taipei Taiwan
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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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Morphet J, Innes K, Griffiths DL, Crawford K, Williams A. Resident transfers from aged care facilities to emergency departments: can they be avoided? Emerg Med Australas 2015; 27:412-8. [PMID: 26095333 PMCID: PMC4745031 DOI: 10.1111/1742-6723.12433] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
Objective Residents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations. Methods A retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be ‘potentially avoidable’. Results There were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy‐one residents (17.4%) were identified as being potentially avoidable transfers. Conclusion Many resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services.
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Affiliation(s)
- Julia Morphet
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kelli Innes
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra L Griffiths
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Allison Williams
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Stokoe A, Hullick C, Higgins I, Hewitt J, Armitage D, O'Dea I. Caring for acutely unwell older residents in residential aged-care facilities: Perspectives of staff and general practitioners. Australas J Ageing 2015; 35:127-32. [DOI: 10.1111/ajag.12221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Stokoe
- Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Carolyn Hullick
- Division of Emergency Medicine; John Hunter Hospital Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Isabel Higgins
- School of Nursing and Midwifery; Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
- Centre for Practice Opportunity and Development; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Jacqueline Hewitt
- Emergency Department; John Hunter Hospital; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Deborah Armitage
- Older Person Acute Care; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - Ian O'Dea
- Older Persons Journey; Community Health Strategy; Hunter New England Local Health District; Newcastle New South Wales Australia
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Hutchinson AF, Parikh S, Tacey M, Harvey PA, Lim WK. A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation. Age Ageing 2015; 44:365-70. [PMID: 25536957 DOI: 10.1093/ageing/afu196] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/12/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services. OBJECTIVE to evaluate whether the RECIPE service decreased acute healthcare utilisation. DESIGN a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment. SETTING a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment. SUBJECTS there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female. METHODS data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter. RESULTS in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003). CONCLUSIONS this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates.
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Affiliation(s)
- A F Hutchinson
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - S Parikh
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia
| | - M Tacey
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia Melbourne Epicentre, Royal Melbourne Hospital, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - P A Harvey
- Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - W K Lim
- Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Freed GL, Gafforini S, Carson N. Age distribution of emergency department presentations in Victoria. Emerg Med Australas 2015; 27:102-7. [PMID: 25690308 DOI: 10.1111/1742-6723.12368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patterns of ED utilisation over time, by patient age group and triage classification. METHODS Secondary analysis of data from all patients presenting to EDs in Victoria utilising the Victorian Emergency Minimum Dataset (VEMD) for the years 2002-2013. The VEMD includes all hospitals in Victoria with 24 h EDs. RESULTS The absolute number of presentations to EDs in Victoria has grown by over 52% in the last 11 years. The triage categories of highest urgency (1-3) grew by 89% whereas the categories of lowest urgency (4-5) grew by 33%. Over this period, the 5 year age band with the greatest number of ED presentations has consistently been, by far, children 0-4 years of age. This age group has seen an increase of 29% in ED presentations overall with a >55% increase in Triage 1-3, and an increase of 16% in triage 4-5. For all age groups, there has been little change in the number of triage category 4-5 presentations since 2007/2008. However, for triage categories 1-3, there have been consistent increases in presentations across all age groups. CONCLUSION The age range with the greatest absolute number of ED presentations in Victoria is children 0-4 years of age. This finding is consistent over time and across all triage classifications. The age range with the second highest absolute number of ED presentations is comprised of those 20-24 years of age. This is in contrast to the frequent public attention placed on the volume of ED presentations by the elderly.
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Affiliation(s)
- Gary L Freed
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Abstract
RÉSUMÉL'insuffisance cardiaque (IC) est fréquente chez les résidents en soins de longue durée (SLD), et peut représenter 40 pour cent des transferts aux soins aigus. Des lignes directrices de l’IC de la Société canadienne de cardiologie approuvent les traitements standards, mais les résidents de SLD sont moins susceptibles de recevoir un traitement.* Cette étude qualitative a utilisé des groupes de discussion pour explorer les perceptions, de 18 médécins et infirmières praticiennes dans trois foyers de l’Ontario, des pratiques de soins de l’IC et les défis de SLD. Par exemple, les participants ont rapporté les défis concernant aptitudes diagnostiques et les connaissances procédurales de l’IC. Ils ont également identifié la nécessité de la collaboration interprofessionnelle et la clarification des rôles pour améliorer les soins et les résultats de l’IC. Pour résoudre ces problèmes, les interventions multi-modales et l'enseignement de chevet sont requis. Le leadership a été considéré comme essentielle pour améliorer les soins de l’IC. Plusieurs préoccupations ont surgi concernant les lacunes dans les connaissances et les déficits cliniques chez les fournisseurs de soins primaires qui traitent l'insuffisance cardiaque chez les résidents de SLD. Pour améliorer les soins de l'IC à long terme, des solutions éducatives et interprofessionnelles multi-modales et cliniquement ciblées sont nécessaires.
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Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review. BMC Geriatr 2014; 14:80. [PMID: 24952409 PMCID: PMC4094601 DOI: 10.1186/1471-2318-14-80] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents. Method Systematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data. Results Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools. Conclusions Most assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.
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Griffiths D, Morphet J, Innes K, Crawford K, Williams A. Communication between residential aged care facilities and the emergency department: a review of the literature. Int J Nurs Stud 2014; 51:1517-23. [PMID: 24996849 DOI: 10.1016/j.ijnurstu.2014.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Western countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common. OBJECTIVE The purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department. METHODS A literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: 'nursing home', 'long-term care', 'skilled nursing facility', 'aged care facility', 'communication', 'documentation', 'emergency department', 'emergency room', 'hospital', 'acute', 'transfer', and 'transition'. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained. RESULTS There is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes 'essential transfer information', clinical practices will continue to vary and resident care will be affected. CONCLUSION This paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.
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Affiliation(s)
- Debra Griffiths
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia.
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Kelli Innes
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Kimberley Crawford
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Allison Williams
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
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Morphet J, Griffiths DL, Innes K, Crawford K, Crow S, Williams A. Shortfalls in residents' transfer documentation: challenges for emergency department staff. ACTA ACUST UNITED AC 2014; 17:98-105. [PMID: 25113312 DOI: 10.1016/j.aenj.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Increasing numbers of residents are transferred from aged care facilities to emergency departments. Frequently, residents arrive with inadequate documentation regarding their presenting complaint or medical history, making it difficult for emergency department staff to make decisions about care. METHODS A retrospective review of emergency department records was undertaken for residents transferred from residential aged care facilities to two emergency departments in Melbourne, Victoria in 2012. RESULTS 2880 resident transfers were included in the sample, of which 408 transfers were randomly selected for documentation review. Clinically important documentation was frequently absent including: the reason for transfer to the ED (n=197, 48.2%); baseline cognitive function (n=244, 59.7%); and vital signs at time of complaint (n=285, 69.9%). When the reason for transfer was absent, residents with an altered conscious state had more investigations and spent longer in the emergency department than when the reason for transfer was recorded. CONCLUSION Inadequate documentation negatively impacted the resident's journey through the emergency department. There is evidence that inadequate documentation contributes to poor patient outcomes. To minimise the gaps in the transfer documentation regular staff development and quality assurance programs may be required in residential aged care facilities.
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Affiliation(s)
- Julia Morphet
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia.
| | - Debra L Griffiths
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Kelli Innes
- School of Nursing & Midwifery, Monash University, Berwick Campus, Clyde Road, Berwick, Australia
| | - Kimberley Crawford
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Sally Crow
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
| | - Allison Williams
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Australia
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Street M, Considine J, Livingston P, Ottmann G, Kent B. In-reach nursing services improve older patient outcomes and access to emergency care. Australas J Ageing 2014; 34:115-20. [PMID: 24571401 DOI: 10.1111/ajag.12137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. METHODS Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. RESULTS Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). CONCLUSIONS There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.
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Affiliation(s)
- Maryann Street
- Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia
- Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia
| | - Julie Considine
- Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia
- Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia
| | - Patricia Livingston
- Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia
- Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia
| | - Goetz Ottmann
- Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia
- Uniting Care Community Options, Glen Waverley, Victoria, Australia
| | - Bridie Kent
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Laging B, Bauer M, Ford R, Nay R. Decision to transfer to hospital from the residential aged care setting: a systematic review of qualitative evidence exploring residential aged care staff experiences. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging 2014; 9:165-77. [PMID: 24477218 PMCID: PMC3894957 DOI: 10.2147/cia.s46058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.
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Affiliation(s)
- Ching Jou Lim
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Rhonda L Stuart
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia ; Department of Medicine, Monash University, Clayton, VIC, Australia
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Heckman GA, Foebel AD, Dubin JA, Ng J, Turpie ID, Hussack P, McKelvie RS. The Value of Admission Clinical Data for Diagnosing Heart Failure in Long-term Care. Can Geriatr J 2013; 16:147-55. [PMID: 24278092 PMCID: PMC3837714 DOI: 10.5770/cgj.16.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents. Methods This was a prospective cohort study. From February 2004 to November 2006, information about new residents from 41 LTC homes in Ontario, Canada, was collected from residents and caregivers, and all available health records. A prior HF diagnosis was confirmed by consensus review of available data by two independent experts. Multivariate modelling was utilized to determine the utility of the admission clinical assessment in confirming a prior HF diagnosis. Results A total of 449 residents were included for analysis, aged 84.3±6.5 years, and 21.6% had a prior HF diagnosis. The most useful clinical item for diagnosing HF was a “history of HF”. The final model included “history of HF’ (OR [odds ratio] 13.66, 95% CI 6.61–28.24), “fluid on the lungs” (OR 2.01, 95% CI 1.04–3.89), “orthopnea” (OR 1.76, 95% CI 0.93–3.33), “taking β-blocker” (OR 2.09, 95% CI 1.10–3.94), “taking loop diuretics” (OR 2.11, 95% CI 1.12–3.98), and “history of coronary artery disease” (OR 2.83, 95% CI 1.42–5.64). Conclusion Elements of the clinical assessment for new LTC residents can help confirm a prior HF diagnosis. An admission history of HF is highly predictive.
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Affiliation(s)
- George A Heckman
- Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Kitchener, ON
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Lane H, Philip J. Managing expectations: Providing palliative care in aged care facilities. Australas J Ageing 2013; 34:76-81. [PMID: 24521162 DOI: 10.1111/ajag.12085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore the views and experiences of staff from RACFs and community palliative care services (CPCSs) on providing palliative and end-of-life care in RACFs. METHOD Qualitative exploratory interviews and focus groups were conducted with staff working in two RACFs and two CPCSs, and, following data saturation, a thematic analysis undertaken. RESULTS 15 RACF and 15 CPCS staff participated. The overarching theme was of managing expectations in the provision of care. This included low expectations of the care available in RACFs, tensions in addressing complex decision-making and concurrent administrative expectations, and differences between views of RACF and CPCS staff regarding their respective roles. CONCLUSION Improved understanding of the needs of RACF staff will improve the care of residents and, in turn, reduce hospitalisations.
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Affiliation(s)
- Heather Lane
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia
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Lane H, Zordan RD, Weiland TJ, Philip J. Hospitalisation of high-care residents of aged care facilities: are goals of care discussed? Intern Med J 2013; 43:144-9. [DOI: 10.1111/j.1445-5994.2012.02749.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/18/2012] [Indexed: 12/17/2022]
Affiliation(s)
- H. Lane
- Centre for Palliative Care; St Vincent's Hospital and University of Melbourne; Victoria; Australia
| | - R. D. Zordan
- Centre for Palliative Care; St Vincent's Hospital and University of Melbourne; Victoria; Australia
| | - T. J. Weiland
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Victoria; Australia
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Taylor MJ, Edvardsson D, Horey D, Fetherstonhaugh D, Nay R, Swerissen H. General practitioner service provision in residential aged care facilities: 1998-2011. Australas J Ageing 2012; 32:56-9. [DOI: 10.1111/j.1741-6612.2012.00647.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J Taylor
- Australian Centre for Evidence Based Aged Care; Australian Institute for Primary Care and Ageing; Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
| | - David Edvardsson
- Austin Health Clinical School of Nursing; School of Nursing and Midwifery; Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
| | - Dell Horey
- Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care; Australian Institute for Primary Care and Ageing; Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
| | - Rhonda Nay
- Australian Centre for Evidence Based Aged Care; Australian Institute for Primary Care and Ageing; Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
| | - Hal Swerissen
- Faculty of Health Sciences; La Trobe University; Bundoora; Victoria; Australia
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Georgiou A, Marks A, Braithwaite J, Westbrook JI. Gaps, disconnections, and discontinuities--the role of information exchange in the delivery of quality long-term care. THE GERONTOLOGIST 2012; 53:770-9. [PMID: 23103520 DOI: 10.1093/geront/gns127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. DESIGN AND METHODS A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 individual interviews and observation sessions. RESULTS The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a diverse number of internal and external communication channels that are important for the organization of care. IMPLICATIONS The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.
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Affiliation(s)
- Andrew Georgiou
- Address correspondence to Andrew Georgiou, Centre for Health Systems & Safety Research, University of New South Wales, Australian Institute of Health Innovation, Level 1, AGSM Building, Sydney, New South Wales 2052, Australia. E-mail:
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Cunningham P, Sammut J. Inadequate acute hospital beds and the limits of primary care and prevention. Emerg Med Australas 2012; 24:566-72. [PMID: 23039300 DOI: 10.1111/j.1742-6723.2012.01601.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2012] [Indexed: 11/29/2022]
Abstract
Metropolitan Australia is suffering from a serious shortage of acute hospital beds. Simplistic comparisons with the Organisation for Economic Co-operation and Development bed numbers are misleading because of the hybrid Australian public/private hospital system. The unavailability of most private beds for acute emergency cases and urban/rural bed imbalances have not been adequately considered. There is a lack of advocacy for acute bed availability. This attitude permeates government, health professions and the health bureaucracy. Planners, politicians, analysts and the media have adopted false hopes of reducing acute demand by prevention and primary care strategies, vital as these services are to a balanced healthcare system. This paper directly challenges the ideology that says Australia depends too heavily on hospital-based healthcare. Rebuilding the bed base requires recognition of the need for an adequate acute hospital service and strong advocacy for bed-based care in the medical and nursing professionals who should be driving policy. The forces opposing bed-based care are strong and solutions might include legislative definition of bed numbers and availability.
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Affiliation(s)
- Paul Cunningham
- Emergency Department, Ryde Hospital, Eastwood, New South Wales, Australia.
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