Reducing hospital admissions from nursing homes: a systematic review

Abstract

BackgroundThe geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes.MethodsA systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination.ResultsFive systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach.ConclusionsOverall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.

Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States

“…These findings may complement important efforts already underway to reduce preventable ED visits and hospital admissions in nursing home residents. 3,5,26 Future work based on these findings includes: 1) developing evidence-based algorithms that accurately predict fall-related injury in nursing home residents that could be used at the point of care to help decide whether ED transfer is needed; 2) developing clinical prediction rules that accurately identify serious head injury in older adults to reduce need and improve accuracy of CT scanning; 3) reviewing Emergency Department records to identify nursing home residents who did not undergo any diagnostic testing, and the circumstances of these visits. Our findings also highlight the importance of improving ED-nursing home communication as nursing home residents often undergo testing and receive treatments (including centrally-acting, sedating medications) in the ED that have implications for evaluation and subsequent care in the nursing home.…”

Effects of Early Dual‐Eligible Special Needs Plans on Health Expenditure

“…; Loeb et al. ; Graverholt, Forsetlund, and Jamtvedt ). Therefore, coordinating health care delivery between nursing homes and hospitals could generate cost savings.…”

Experience of establishing an acute geriatric outreach service versus subacute service to nursing homes

“…Our positive result is echoed by some, [8][9][10][11] but not others. 8,15,16 Other factors for success in hospital avoidance include support, appropriate training and skills for staff caring for NH patients. nature of intervention and acuity of illnesses), and the differences in staffing mix or expertise may be some reasons for inconsistent results.…”