Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review

Cetin-Sahin, Deniz; Gore, Geneviève; Cummings, Greta G.; Vedel, Isabelle; Karanofsky, Mark; Voyer, Phillippe; Gore, Brian F.; Lungu, Ovidiu; Wilchesky, Machelle

doi:10.1016/j.jamda.2022.12.025

Cited by 2 publications

(2 citation statements)

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“…Existing research on RACF to ED transitions focuses on knowledge creation (e.g., quantifies and presents factors associated with care transitions; Trahan et al, 2016 ), investigates strategies to prevent transitions from occurring ( Cetin-Sahin et al, 2023 ; Grant et al, 2020 ), seeks to improve limited components of care (e.g., medication reconciliation; Chhabra et al, 2012 ; Grant et al, 2020 ), or describes staff perspectives and experiences of transitions ( Chhabra et al, 2012 ; Gettel et al, 2020 ; LaMantia et al, 2016 ). Although most reviews examine traditional measures of intervention effectiveness (e.g., reduction in transfer rates), few authors have examined implementation processes simultaneously with the aforementioned measures ( Proctor et al, 2011 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

Tate,

Cummings,

Jacobsen

et al. 2024

The Gerontologist

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Background and Objectives Older adults residing in residential aged care facilities (RACFs) often experience sub-standard transitions to emergency departments (EDs) through rationed and delayed ED care. We aimed to identify research describing interventions to improve transitions from RACFs to EDs. Research Design and Methods In our scoping review, we included English language articles that 1) examined an intervention to improve transitions from RACF to EDs, and 2) focused on older adults (>65 years). We employed content analysis. Dy et al.’s Care Transitions Framework was used to assess the contextualization of interventions and measurement of implementation success. Results Interventions in 28 studies included: geriatric assessment or outreach services (n=7), standardized documentation forms (n=6), models of care to improve transitions from RACFs to EDs (n=6), telehealth services (n=3), nurse-led care coordination programs (n=2), acute-care geriatric departments (n=2), an extended paramedicine program (n=1), and a web-based referral system (n=1). Many studies (n=17) did not define what ‘improvement’ entailed and instead assessed documentation strategies and distal outcomes (e.g., hospital admission rates, length of stay). Few authors reported how they contextualized interventions to align with care environments and/or evaluated implementation success. Few studies included clinician perspectives and no study examined resident or family/friend caregiver reported outcomes. Discussion and Implications Mixed or non-significant results prevent us from recommending (or discouraging) any interventions. Given the complexity of these transitions and the need to create sustainable improvement strategies, future research should describe strategies used to embed innovations in care contexts and to measure both implementation and intervention success.

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Section: Background and Objectivesmentioning

confidence: 99%

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

Tate,

Cummings,

Jacobsen

et al. 2024

The Gerontologist

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“…(22,31) In our recent systematic scoping review of interventions aimed at reducing transfers from LTC, we found that reported outcomes were almost always limited to all transfers (i.e., regardless of avoidability specification), (32)(33)(34)(35)(36)(37)(38)(39)(40) while only three studies (41)(42)(43) (representing 3.3% of the review study sample) measured PAEDTs as their primary outcome. (44) These three studies adapted the ambulatory care sensitive condition approach in different ways, which speaks to the need for harmonizing definitions. More to the point, however, is the fact that PAEDTs are seldom measured in the literature, perhaps due to challenges with their measurement.…”

Section: Figure 2 Principal Emergency Department and Hospital Admissi...mentioning

confidence: 99%

Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study

Cetin-Sahin,

Karanofsky,

G. Cummings

et al. 2023

Can Geriatr J

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Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% ‘PAEDT only’, 11.6% ‘both PAEDT & PAH’, and 1.9% ‘PAH only’. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the ‘both PAEDT & PAH’ category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.

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Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review

Cited by 2 publications

References 50 publications

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study

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