Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations

Abstract

The purpose of this study was to describe nursing home resident symptomatology and medical diagnoses associated with nursing home to hospital transfers. A retrospective chart review of documented transfers was conducted at a 120-bed, nonprofit urban Continuing Care Retirement Center nursing home facility located in the southwestern United States. The transferred residents (n = 101) had seventy different medical diagnoses prior to hospital transfer with hypertension, coronary artery disease, and congestive heart failure most frequently reported. Most frequently reported symptomatology included fatigue, lethargy or weakness, shortness of breath, and change in level of consciousness. Multiple symptomatology was indicative of a wide variety of medical diagnoses. The diagnoses and symptomatology recorded in this paper identify the importance of strategic planning concerning assessment and communication of common nursing home resident symptomatology and the importance of basic nursing and diagnostic procedures for prevention of potentially avoidable hospitalizations.

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

“…Lack of resources in NH facilities was a significant barrier in providing timely and high-quality care. 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.…”

“…1e3,10e18 The concept of "avoidable" is complex and multifactorial, and the decisionmaking process includes dilemmas of resource availability and utilization, 7,19,20 NH resident and family member preferences of care, 7,17,21,22 and macro health system issues of scope of practice and accreditation standards. 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.…”

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

“…aging, such as delirium and syncope. 26 However, training must also take into consideration the different levels of nurses employed in nursing homes and their scope of practice. For example, INTERACT II offers different training modules based on level of nursing.…”

Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective

“…Signs and symptoms of an acute exacerbation can be subtle or difficult to detect and interpret in this population . Delays in recognition can lead to hospitalisation for a problem that could have been managed in the nursing home if detected early . But the capacity for nursing homes to manage and treat certain conditions varies, as nursing homes are not ‘miniature hospitals’ .…”