Reducing Avoidable Hospital Transfers From Nursing Homes in Austria

Abstract

Hospital transfers from nursing homes (NHs) are frequent, burdensome for residents, and often avoidable. The evidence regarding the effectiveness of interventions to reduce avoidable transfers is limited, and most projects focus on nurses’ knowledge and skills. In the present project, interventions focusing on nurses and physicians are integrated, elaborated, and implemented in 17 NHs. Results of the 6 months preintervention period are reported. Hospital transfer rates (N = 1,520) and basic data on all residents (N = 1,238) were collected prospectively. Nurses’ preintervention knowledge and self-efficacy were assessed using standardized questionnaires (N = 330). Many hospital transfers were initiated by nurses without physician involvement, polypharmacy was common, and a high potential for reducing transfers by increasing physician presence was observed. Nurses showed rather low knowledge but high self-efficacy. The results are discussed against the background of the interventions including enhancement of physician presence and geriatric quality circles.

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

“…Taken these together, conflicts and uncertainties may arise making nurses more likely to decide in favour of a hospital transfer compared to physicians. An Austrian study explored that most of unplanned transfers are initiated by nurses without physician involvement [23]. This is also supported by our finding that the majority of GPs thought that the NH staff initiates transfers to hospital too often.…”

“…further functional and mental decline or nosocomial infections [19,20], and lead to a high use of healthcare resources [19,21]. Thus, the existing evidence considers many of these transfers inappropriate or potentially avoidable [21][22][23][24]. However, there are numerous instruments judging the appropriateness of hospital transfers [24,25], and the according proportions of inappropriate transfers vary substantially between 2 and 77% [26,27].…”

“…General practitioners (GPs) provide most medical care for NH residents [4,44] and both groups play essential roles for the transfer decision [36,41,43,45,46]. In Germany, NH residents can be admitted to a hospital with a physician's (e.g., GP's) referral, however, the transfer process can also be initiated by the NH staff calling the emergency medical service without involvement of a physician which is common practice in German speaking countries [23,47]. Several approaches discussed for reducing inappropriate hospital transfers include better interprofessional collaboration [25,33,37,41,48].…”

Dying at home in rural residential aged care: A mixed-methods study in the Snowy Monaro region, Australia

“…At any given time over the 2013–2014 financial year, 7.8% of the Australian population aged over 65 years (270,559 people), were in RAC (Australian Institute of Health & Welfare [AIHW], ). Studies also indicate that transfers from RAC to hospital are common, can be burdensome for residents, and are often avoidable (Arendts & Howard, ; Dwyer, Gabbe, Stoelwinder, & Lowthian, ; Kada, Janig, Likar, Cernic, & Pinter, ; Menec, Nowicki, Blandford, & Veselyuk, ).…”

“…Australia, in common with all developed countries, is facing an increase in its ageing population (Productivity Commission, 2013), with many living with complex and chronic comorbidities. that transfers from RAC to hospital are common, can be burdensome for residents, and are often avoidable (Arendts & Howard, 2010;Dwyer, Gabbe, Stoelwinder, & Lowthian, 2014;Kada, Janig, Likar, Cernic, & Pinter, 2017;Menec, Nowicki, Blandford, & Veselyuk, 2009).…”