Health Care Providers' Opinions on Communication Between Nursing Homes and Emergency Departments

Gillespie, Suzanne M.; Gleason, Lauren J.; Karuza, Jurgis; Shah, Manish N.

doi:10.1016/j.jamda.2009.09.002

Cited by 43 publications

(38 citation statements)

References 8 publications

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“…In our study, the nurses emphasised that a physician had to confirm the older person's health status to the hospital staff. In their survey, Gillespie et al [24] found that both NH and ED staff agreed that communication between them was poor.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the aged population with multiple illnesses, referrals from nursing homes to EDs will probably continue to be common [24]. Although ED documentation and the opinions of ED staff have been examined, the other parties directly involved have not been considered, nor have the circumstances that contributed to the referral decisions, the NH staff members', the older persons' or their relatives' perspectives been illuminated [18].…”

Section: Discussionmentioning

confidence: 99%

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Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses

Kihlgren¹,

Sunvisson²,

Ziegert³

et al. 2014

OJN

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The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme "Shared responsibilities in the best interests of the older person reduce feelings of insufficiency". The content was formulated, which revealed the RNs' feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person's needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the "inner circle" were crucial for the nurses' confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the "outer circle", i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs' and staff members' competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons' health.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses

Kihlgren¹,

Sunvisson²,

Ziegert³

et al. 2014

OJN

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“…1): 13 cross-sectional studies, [15][16][17][18][19][20][21][22][23][24][25][26][27] four cohort studies, [28][29][30][31] two randomized controlled trials, 32,33 and one quasi-experimental study 34 (Table 1). Studies were conducted in the US (n=11), [15][16][17][18][19][20][21]24,28,29,34 Australia (n=6), 22,25,[30][31][32][33] and United Kingdom (n=3). 23,26,27 Most studies evaluated the transition from outpatient clinic to hospital admission (n=9).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…23,26,27 Most studies evaluated the transition from outpatient clinic to hospital admission (n=9). 16,19,[21][22][23]25,27,28,32 Other described transitions included nursing home to the emergency department (four studies), 17,18,20,34 clinic to the emergency department (four studies), 26,30,31,33 and three from an unspecified site to hospital admission. 15,24,29 Overall, the majority of the acute care settings involved are individual hospitals.…”

Section: Description Of Studiesmentioning

confidence: 99%

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review

et al. 2015

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BACKGROUND: Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. METHODS: We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. RESULTS: Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65 %), conducted in the US (55 %), and studied communication between primary care and inpatient providers (62 %). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95 % CI 0.92-1.26). DISCUSSION: The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.KEY WORDS: care transitions; continuity of care; provider-to-provider communication.

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“…Despite the importance of cross-setting communication, the complex, fragmented nature of the U.S. healthcare system leads to significant variability in the frequency, quality and effectiveness of cross-setting communication [8][9][10] . It is increasingly rare for PCPs to follow their patients in the hospital, so hospital physicians must transfer responsibility for patient care to PCPs at hospital discharge [11] .…”

mentioning

confidence: 99%

Is audit and feedback associated with increased hospital adherence to standards for communication during patient care transitions?

Baier

Limpahan

Butterfield

et al. 2014

JHA

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Guidelines to enhance communication during patient care transitions between healthcare settings have the potential to improve patient outcomes and satisfaction, as well as to decrease overall costs. In 2009, Healthcentric Advisors, the Medicare Quality Improvement Organization (QIO) for New England, collaborated with Rhode Island providers and stakeholders to develop communitywide standards for hospitals, the Safe Transitions Best Practice Measures for Hospitals and then implemented a hospital quality improvement intervention. As part of this intervention, 10 of the state's 11 acute-care hospitals collected quarterly data and Healthcentric Advisors provided audit and feedback reports showing each facility's progress and the state's average performance. Using hospital-reported data on four best practice measures and Medicare claims data for Q2 2011-Q1 2013, we performed descriptive analyses of (1) inpatient-to-outpatient communication for all patients at the 10 participating hospitals, as measured by four best practice measures, and (2) state-wide all-cause, 30-day readmission rates per 1,000 fee-for-service (FFS) beneficiaries. Aggregate performance for the four best practice process measures increased by 5.5% to 217.6% for all patients who met eligibility criteria (p ≤ .001 for each measure) and the readmission rate decreased by 18.4% from 14.12 to 11.52 per 1,000 eligible FFS Medicare beneficiaries (p ≤ .001). These findings suggest that communitywide standards, such as the Safe Transitions Best Practice Measures for Hospitals, and audit and feedback interventions can successfully improve hospitals' communication during patient care transitions between healthcare settings.

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Health Care Providers' Opinions on Communication Between Nursing Homes and Emergency Departments

Cited by 43 publications

References 8 publications

Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses

Referrals to Emergency Departments— The Processes and Factors That Influence Decision-Making among Community Nurses

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review

Is audit and feedback associated with increased hospital adherence to standards for communication during patient care transitions?

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