Appropriateness of unscheduled hospital admissions from care homes

Harrison, Jennifer; McKay, Iona; Grant, P T; Hannah, Jean; Quinn, Terence J

doi:10.7861/clinmedicine.16-2-103

Cited by 24 publications

(26 citation statements)

References 23 publications

(24 reference statements)

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“…Harrison et al [39] used a series of vignettes based on common clinical scenarios and found that Scottish physicians and nurses most often agreed that the admission for the case with advanced dementia was inappropriate. This finding is comparable with ours.…”

Section: Discussionmentioning

confidence: 99%

“…For the GP survey the sample size calculation was based on a UK survey among multidisciplinary healthcare professionals (including physicians and nurses) with direct experience in acute care of NH residents. The respondents considered 55% of hospital admissions inappropriate [39]. For estimating a 95% confidence interval (CI) with a precision of ±5% (50-60%) (calculation performed with OpenEpi Version 3.01) we needed a sample size of 381 GPs.…”

Section: Methodsmentioning

confidence: 99%

“…Due to the complexity of the decision for hospital transfers [37], inquiring and understanding the perceptions of healthcare professionals directly involved in this process seems to be a more appropriate way aiming to reduce unnecessary transfers [33,35,36,[38][39][40][41][42][43]. Usually, nursing staff are the first ones identifying a resident's deterioration and they know the complexity of the decision-making process [37].…”

Section: Introductionmentioning

confidence: 99%

“…Several approaches discussed for reducing inappropriate hospital transfers include better interprofessional collaboration [25,33,37,41,48]. However, most of the existing literature on reasons for hospital transfers of NH residents and areas for improvement only focussed on just one of these healthcare professionals [35,37,40,43,48], or had small sample sizes [39,49,50]. Moreover, research on this topic from Germany is rare.…”

Section: Introductionmentioning

confidence: 99%

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Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement. Methods: Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests. Results: We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492). Conclusions: A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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“…In many cases solely specific medical diagnoses belonging to the so called ambulatory care sensitive conditions (ACSCs) were used, for instance, heart failure and pneumonia [18,[28][29][30][31][32]. However, most of these proxies do not consider the heterogeneity of situations and the extent of factors influencing the decision for hospital transfers of NH residents [21,24,[33][34][35][36].Due to the complexity of the decision for hospital transfers [37], inquiring and understanding the perceptions of healthcare professionals directly involved in this process seems to be a more appropriate way aiming to reduce unnecessary transfers [33,35,36,[38][39][40][41][42][43]. Usually, nursing staff are the first ones identifying a resident's deterioration and they know the complexity of the decisionmaking process [37].…”

mentioning

confidence: 99%

Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

Fassmer

Pulst

Spreckelsen

et al. 2020

Preprint

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.Methods: Two cross-sectional studies were conducted as surveys among 1,121 GPs in the German federal states Bremen and Lower Saxony and staff from 1,069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.Results : We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p<0.0001; emergency department visits: 39.9% vs. 20.9%, p<0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p=0.0009). Both groups rated almost all potential measures for improvement differently (p<0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p=0.1492).Conclusions : A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Factoren die van invloed zijn op het verwijzen van patiënten van het verpleeghuis naar het ziekenhuis

Huls¹,

Pouw

Nieuwenhuizen

et al. 2018

Tijdschr Gerontol Geriatr

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Appropriateness of unscheduled hospital admissions from care homes

Cited by 24 publications

References 23 publications

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

Factoren die van invloed zijn op het verwijzen van patiënten van het verpleeghuis naar het ziekenhuis

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