Can transfers from residential aged care facilities to the Emergency Department be avoided through improved primary care services? Data from qualitative interviews

Abstract

The transfer of residents from RACF to ED is influenced by multiple interrelated factors, and strategies to reduce transfer should address these.

Reducing inappropriate accident and emergency department attendances:

“…Although actual, 30,42 or perceived, 43 absence of primary care does result in increased emergency attendances, findings from this review support the notion that increasing access points for urgent care may unmask latent demand that is more likely to be inappropriate for A&Es. Cost savings across the urgent care sector as a whole may be negated by the additional cost of providing new services; in addition, there is a risk of service duplication with disruption to continuity of care because of provider proliferation.…”

Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods

“…Eight qualitative studies and two mixed-methods studies were chosen for inclusion in the review because they contained qualitative data on nurses who work in nursing homes perceptions surrounding emergency transfers; however, only the qualitative sections of the mixed-methods studies were considered. 9,16e24 Upon closer examination, three studies were excluded because: nursing home staff voices were not clearly identifiable 21 ; pre and post training carer role changes were the main focus 22 ; nursing staff perceptions beyond views on symptomology were not prominent. 23 Seven studies were included in the final review ( Table 1).…”

Decisions to Transfer Nursing Home Residents to Emergency Departments: A Scoping Review of Contributing Factors and Staff Perspectives

“…7,19,20 This phenomenon triggered policies to not-treat and to transfer because the resident's acuity outweighed the NH's capacity to care for them. 7,8,10,11,15,17,23 Physician/NP Factors Physician/NP factors influencing resident transfer to EDs were explored in 8 studies. The most common finding was the relative absence of a primary care provider in the NH facility, 11,12,15e17,19 which suggests that 1 visit by a physician or NP could potentially prevent an unnecessary transfer.…”

“…18 The current standard of practice, based on the theoretical approach to "unavoidable" or "unnecessary" transfers, is to transfer NH residents to the ED when the care they require exceeds the resources of the NH facility. 18,23 The purpose of this scoping review was to identify characteristics of avoidable or unnecessary transitions of NH residents to EDs, and factors influencing decision-making by NH clinicians (including nurses and physicians), NH residents and their family members when applicable, to transfer residents to EDs for care. This scoping review had 2 objectives: (1) to aggregate existing evidence for decisions to transfer NH residents to EDs, including rationale, motivations, barriers to care in the NH, and NH staff perspectives, and (2) determine what constitutes "avoidable" or "unnecessary" transitions to acute care.…”