Reducing Avoidable Hospitalizations and Improving Quality in Nursing Homes With APRNs and Interdisciplinary Support

Rantz, Marilyn; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy M.; Crecelius, Charles

doi:10.1097/ncq.0000000000000302

Cited by 20 publications

(20 citation statements)

References 12 publications

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“…Studies showed that LTCF residents’ unexpected ED visits are generally caused by clinical emergencies such as sudden changes in their physiological signs, changes in their mental states, and accidents [43]; nurses’ care experience, judgment, and ability to handle these situations are the main factors determining whether a resident is transferred to an ED when a clinical episode occurs [2,44]. Other studies showed that improving LTCF nurses’ ability to accurately assess and handle LTCF’s residents’ health situations can decrease the occurrence of inappropriate ED visits [25,26,45], thereby lowering nurses’ distress levels. This study found that the clinical episodes dimension had an explanatory variance of 37.49%, revealing that when deciding whether to transfer an LTCF resident to an ED, the most pronounced barrier or difficulty experienced by nurses was judging the severity of a clinical episode.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, relevant studies showed that by making proper medical decisions, nurses can reduce residents’ hospitalization and ED visits by 30% and 54.1%, respectively [24–26]. Because of the shortage of effective tools for assessing the barriers and level of difficulty experienced by LTCF nurses when deciding whether to transfer an LTCF resident to the ED, the purposes of this study were to develop a Patient Transfer Decision Difficulty Scale (PTDDS) and test its effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

et al. 2019

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Background and objectivesNurses serve as gatekeepers of the health of long-term care facility (LTCF) residents and are key members deciding whether residents should visit an emergency department (ED). Inappropriate decisions as to ED visits may result in ED overcrowding, excessive medical expenses, and nosocomial infections. Currently, there is a lack of effective tools for assessing the barriers and level of difficulty experienced by LTCF nurses. The purposes of this study were to develop a Patient Transfer Decision Difficulty Scale (PTDDS) and test its effectiveness.MethodsThis study randomly sampled LTCFs in Taiwan and surveyed two or three nurses in every institution selected. Registered return envelopes were provided for participants to return self-completed questionnaires. Three steps were used to develop the scale and items: in step I, the instrument was developed; in step II, psychometric testing was conducted, which entailed performing an exploratory factor analysis (EFA) to verify the construct validity and reliability of the developed items; and in step III, a confirmation study was conducted using a confirmatory factor analysis (CFA) and structural equation modeling to cross-validate the factors and items.ResultsThe cumulative sum of variance explained by the measurement models of the three factors in the PTDDS was 63.54%.When deciding whether to transfer LTCF residents to EDs, the most pronounced barrier experienced by nurses were for judging the severity of “clinical episodes”, which had an explanatory power of 37.49%. The second and third pronounced barriers and decision difficulty experienced by nurses were “communication and information” and “timing of the residents’ emergency visits,” which explained 16.81% and 9.24% of the variance, respectively.ConclusionsThe cross-validation results obtained using the EFA and CFA showed favorable reliability and validity of the PTDDS. For future studies, this study recommends performing large-scale investigations of the level of decision difficulty and related factors experienced by nurses in LTCFs of varying levels and types.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

et al. 2019

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“…The transfer of LTCF residents to the ED is an important indicator for measuring the quality of care provided by an LTCF (Lemoyne, 2019), and transferring LTCF residents to the ED for treatment is also a part of long‐term care (Trahan et al., 2016). Appropriate decision‐making by nurses can reduce LTCF resident hospitalization by 30% and LTCF resident transfers to the ED by 54.1% (Jensen et al., 2009; Rantz et al., 2018). According to Robinson et al.…”

Section: Introductionmentioning

confidence: 99%

Decision difficulties of long‐term‐care facility nurses in transferring residents to the emergency department: A cross‐sectional nationwide study

Chen

Lai

Tsao

et al. 2021

Journal of Advanced Nursing

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Aims To examine the level of decision difficulties of long‐term‐care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. Design A cross‐sectional nationwide study. Methods The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. Results In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel‐bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). Conclusions Enhancing emergency training in LTCF can improve nurses' decision‐making ability to refer LTCF residents to emergency treatment. Impact What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision‐making. ‘Transfer timing’ was most often considered in the decision‐making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision‐making ability and suitability of transferring residents for emergency treatment.

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“…Today, the quality of care in health care systems draws even more attention and scrutiny (7). Naturally, the quality of hospital processes and services cannot be improved without the active pursuit of patient satisfaction and special attention to patients' needs and expectations in terms of comfort as well as clinical services (8).…”

Section: Introductionmentioning

confidence: 99%

Care Needs and Preferences from Perspective of COVID-19 Patients: A Qualitative Study

Moayed

Heidaranlu

Parandeh

2020

Preprint

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Background: COVID-19 epidemic is one of the major health problems all over the world due to its amazing spreading power and potential damage. Given the increasing prevalence of the disease, identifying the care needs and preferences of patients will play a very important role in providing effective training and caring programs for them. This study aimed to explain the Preferences and needs of care based on the experiences of people with COVID-19.Methods: This qualitative study was carried out over a period of 2 months in medical and recovery units of COVID-19 referral hospitals in Tehran, the capital of Iran in 2020. The Participants consisted of 15 COVID-19 patients selected through purposive sampling.Results: The results were classified into five main categories as “Access to desirable care and comfort services”, “Access to education and information from credible sources”, “Access to specialized care” “Support-social needs” and “Need for deep emotional interactions”.Conclusions: According to the results, identifying priorities and care needs from the perspective of patients with COVID-19 can help improve knowledge, reduce unrealistic patient concerns, and improve emotional interactions between patients and health care providers.

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Reducing Avoidable Hospitalizations and Improving Quality in Nursing Homes With APRNs and Interdisciplinary Support

Cited by 20 publications

References 12 publications

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

Decision difficulties of long‐term‐care facility nurses in transferring residents to the emergency department: A cross‐sectional nationwide study

Care Needs and Preferences from Perspective of COVID-19 Patients: A Qualitative Study

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