Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form

Abstract

Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

“…The authors of three studies evaluated healthcare professionals’ perspectives on whether using standardized documentation forms improved their understanding of patient needs and ability to care for patients ( Madden et al, 1998 ), and also assessed form uptake ( Belfrage et al, 2009 ; McLane et al, 2022 ) and item completion ( McLane et al, 2022 ; Terrell et al, 2005 ). Belfrage et al (2009) reported that form uptake was high (89%) for eligible cases, whereas McLane et al (2022) reported lower form uptake (43%; McLane et al, 2022 ). Item completion improved or was perceived to have improved (by RACF, emergency medical services [EMS], and ED staff) in both studies ( McLane et al, 2022 ; Terrell et al, 2005 ).…”

“… Belfrage et al (2009) reported that form uptake was high (89%) for eligible cases, whereas McLane et al (2022) reported lower form uptake (43%; McLane et al, 2022 ). Item completion improved or was perceived to have improved (by RACF, emergency medical services [EMS], and ED staff) in both studies ( McLane et al, 2022 ; Terrell et al, 2005 ).…”

“…Generally, the authors did not explicitly describe how they embedded the form content and documentation process to meet the needs of study participants (as in these studies, the authors led form development or adaptation). McLane et al (2022) reported that form content was based on findings from earlier research identifying issues that residents, family members, and staff reported during the transition process. The authors discuss how contextual factors influenced intervention implementation and success.…”

“…The authors discuss how contextual factors influenced intervention implementation and success. Key factors included early engagement with relevant stakeholders ( Madden et al, 1998 ); complexity and layout of the form ( Dalawari et al, 2011 ); recognizing that participants had limited time in emergency situations ( Dalawari et al, 2011 ; McLane et al, 2022 ); and ensuring that processes aligned with healthcare professional values about formal record keeping ( McLane et al, 2022 ). The noted challenges included the use of multiple (existing and new) forms ( McLane et al, 2022 ), lack of a single point of leadership and oversight during a transition, and staff mix and turnover ( Dalawari et al, 2011 ; Tsai & Tsai, 2017 ).…”

“…The authors of a recent systematic review ( Gettel et al, 2020 ) also reported a lack of measures to assess critical events during care transitions such as medication errors, duplicative diagnostic testing and procedures, and adverse events. Other literature suggests that documentation interventions should be integrated into electronic recordkeeping and be accompanied with cross-setting education that supports a geriatric focus ( McLane et al, 2022 ; Tate et al, 2023 ). We recommend that researchers examine the quality and consistency of documentation (vs measuring form uptake and item completion) using more robust, mixed-method approaches.…”