Improving the emergency medical treatment of older nursing-home residents

Turrell, Adrian; Castleden, C. M.

doi:10.1093/ageing/28.1.77

Cited by 16 publications

(14 citation statements)

References 86 publications

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“…[4][5][6][9][10][11][12][13] Some have recommended studying the use of a standard form that may increase the transfer of important information between the two facilities. 4,7 Madden et al 8 identified emergency physician and nurse satisfaction with use of a one-page standard ECF-to-ED transfer form; however, their study was not designed to measure the transfer form's effectiveness in increasing the communication of information between facilities, or to measure the compliance of ECFs in completing the form.…”

Section: Discussionmentioning

confidence: 99%

An Extended Care Facility-to-Emergency Department Transfer Form Improves Communication

Terrell¹,

Brizendine

Bean³

et al. 2005

Academic Emergency Medicine

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Objectives: Previous studies have established that essential information is inconsistently provided during the transfer of extended care facility (ECF) patients to the emergency department (ED). The authors tested the hypothesis that a one-page, standard ECF-to-ED transfer form would change the rate of successful documentation of ECF patient information. Methods: The design was a pre-and postintervention investigation. The setting was the Methodist Hospital ED, an urban teaching facility in Indianapolis, Indiana. The population included consecutive patients transferred from ECFs to the ED. The intervention consisted of the introduction of a one-page, standard ECF-to-ED transfer form that listed 11 data elements that are critical for patient care. The completed form was to be sent with patients transferred to the ED. Successful documentation was defined as the recording of at least nine of 11 data elements. Results: In the preintervention period, the ED received 130 transfers from 41 ECFs. Sixty-five of 130 transfers were from ten ECFs, which were the targets of the intervention. In the postintervention period, 72 consecutive transfers from ten ECFs were studied. Postintervention, the proportion of transfers with successful documentation was 77.8% (56 of 72), an increase of 19.3% (95% CI = 4.0% to 34.7%) over the preintervention period. In 31.9% (23 of 72) of postintervention ED transfers, the transfer form was transported with the patient. Successful documentation was achieved in 22 (95.6%) of these 23 transfers. Conclusions: Use of a one-page, standard ECF-to-ED transfer form increased the amount of essential data provided to the ED.

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Section: Discussionmentioning

confidence: 99%

An Extended Care Facility-to-Emergency Department Transfer Form Improves Communication

Terrell¹,

Brizendine

Bean³

et al. 2005

Academic Emergency Medicine

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“…with technologies that are not available in some NHs/ECFs. Advanced training of paramedics to enable them to assess and treat minor conditions of NH/ECF residents, avoiding ED visits, could reduce inappropriateness, but caution should be taken against excluding older people from the best possible care [17]. A crucial point in these patients is two-way communication between the two sources of medical care [18].…”

Section: The Epidemiological Loadmentioning

confidence: 99%

The elderly in the emergency department: a critical review of problems and solutions

et al. 2007

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The elderly are an ever increasing population in overcrowded emergency departments (EDs) in many countries. They have multiple health problems and consume more time and resources than younger patients. They are more frequently admitted and experience adverse outcomes after they are discharged from the ED. These frail patients could require specific skills, instruments and organisational models of emergency care in order to look after their complex needs. As such, several approaches have been tried and tested to improve emergency care for them. This article analyses the epidemiological load and problems faced when confronted with elder ED patients. We critically review organisational models, clinical approaches and methodologies in order to reduce ED physicians' difficulties and to improve quality of care and outcomes for elder patients. Triage, clinical assessment and discharge are identified as critical moments during an emergency care process, and interesting and useful instruments are proposed as possible solutions.

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“…This may increase the likelihood that some residents are admitted to hospital at the very end of life who might otherwise be supported in the care home setting. 20 …”

Section: Introductionmentioning

confidence: 99%

Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England

2011

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Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of ‘key’ external advocates and leverage of additional resources by adoption of care pathway tools.

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Improving the emergency medical treatment of older nursing-home residents

Cited by 16 publications

References 86 publications

An Extended Care Facility-to-Emergency Department Transfer Form Improves Communication

An Extended Care Facility-to-Emergency Department Transfer Form Improves Communication

The elderly in the emergency department: a critical review of problems and solutions

Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England

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