Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates

Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

doi:10.1002/nop2.68

Cited by 20 publications

(22 citation statements)

References 33 publications

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“…Kirsebom et al 2015;Temple et al 2017). Aufgrund der Risikostruktur der Pflegeheimbewohner können die Risiken eines Krankenhausaufenthalts erheblich sein.…”

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Qualitätsmessung mit Routinedaten in deutschen Pflegeheimen: Eine erste Standortbestimmung

et al. 2018

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In Kontrast zu 780.000 hochbetagten und multimorbiden Menschen in deutschen Pflegeheimen steht die umfassend untersuchte Fehlversorgung in diesen Einrichtungen. Der Optimierungsbedarf zur Versorgungstransparenz und-qualität ist erheblich. Ausgehend von der These, dass ein multidimensionaler, sektoren-und berufsübergreifender Blick auf die Versorgungsqualität im Pflegeheim erforderlich ist, testeten die Autoren erstmals in Deutschland die Nutzung von Routinedaten der Kranken-und Pflegekassen (AOK) für diesen Kontext. Hierfür wurden insgesamt sechs Kennzahlen zur Arzneimittelversorgung, zu nosokomialen Erkrankungen, zu Hospitalisierungen sowie zur haus-und fachärztlichen Versorgung im Pflegeheim entwickelt und empirisch getestet. Im Ergebnis zeigt sich, dass die Operationalisierung routinedatenbasierter Qualitätskennzahlen für das stationäre Pflegesetting machbar ist. Auch die zum Teil erheblichen Versorgungsunterschiede zwischen den Pflegeheimen werden transparent gemacht. Auf der Agenda stehen nun die methodische Schärfung und Risikoadjustierung, damit langfristig routinedatenbasierte Qualitätsindikatoren die Entwicklung der pflegeheiminternen Qualität und die Versorgungstransparenz für die Pflegekassen empirisch unterstützen können. In contrast to 780,000 elderly and multimorbid people in German nursing homes, there is an extensively analysed poor care in these facilities. The need for an improved transparency and quality of care is considerable. Based on the assumption that a multidimensional, cross-sectoral and cross-occupational view of the quality of care in nursing homes is called for, the authors tested the use of routine data from health and nursing insurance funds (AOK) for the first time in Germany for this context. For this purpose, a total of six key data on provision of medicines, nosocomial diseases, hospitalisations and general and specialist care in nursing homes were developed and empirically tested. The results show that the operationalisation of routine data-based quality indicators for inpatient care setting is feasible. The sometimes considerable differences in care between nursing homes are also made transparent. Methodological sharpening and risk adjustment are now on the agenda so that routine data-based quality indicators can empirically support the development of nursing home quality and provide transparency for the nursing care insurance funds in the long run.

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“…Kirsebom et al 2015;Temple et al 2017). Aufgrund der Risikostruktur der Pflegeheimbewohner können die Risiken eines Krankenhausaufenthalts erheblich sein.…”

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“…»relocation stress« -verbunden mit Orientierungslosigkeit, Depression und damit einer ggf. stark beeinträchtigten Lebensqualität (Keville 1993;Kirsebom et al 2015). Daraus abgeleitet testet der vorliegende Beitrag auch die Verwendung der heimbezogenen Häufigkeit von ASK als Kennzahl in der routinedatenbasie rten Qualitätsmessung im Pflegeheimsetting.…”

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Qualitätsmessung mit Routinedaten in deutschen Pflegeheimen: Eine erste Standortbestimmung

et al. 2018

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“…15 There is also evidence that nursing homes with less training have higher transfer rates to emergency departments. 16 This study has several limitations. First, 6 of 20 nursing homes were selected randomly for the survey; although they had similar demographics to those not selected and power was calculated in advance, generalizability may be compromised.…”

Section: Discussionmentioning

confidence: 92%

Does an Interactive, Teleconference-Delivered, Palliative Care Lecture Series Improve Nursing Home Staff Confidence?

Dowling

Payne

Larkin

et al. 2020

Journal of Palliative Medicine

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Background: Project ECHOÔ (Extension for Community Healthcare Outcomes) is a form of online interactive teaching, which has gained international traction. This project evaluates the effectiveness of an ECHOdelivered palliative care education program for the South Dublin region of Ireland. Our aim was to measure project success by quantifying gains in staff confidence. Methods: The educational program consisted of 10 interactive sessions over a five-month period on palliative care topics ranging from pain management to advance care planning. Twenty nursing homes took part in the education program. Of these, a subgroup of six nursing homes were randomly selected for assessment. Likert scale-based questionnaires assessed staff confidence before and after each lecture and assessment was repeated at least six weeks postlecture. Five of the 10 sessions were assessed in this way. Other characteristics such as staff role and years of experience were also collected. Results: Twenty nursing homes and 353 staff participated in the education sessions. Of the 6 nursing homes chosen for assessment, an average of 42 questionnaires were returned per session (n = 211), representing 83% of attendees at these 6 selected nursing homes. Seventy-seven percent of questionnaires were successfully followed up for six weeks. Average confidence increased by 27% pre-to postlecture (6.4 [SD = 1.4] to 8.1 [SD = 2.1], p < 0.005). Confidence gains persisted at six weeks; 8.1 of 10 (SD = 1.4), with no significant drop-off (-0.01/10, p = 0.95). All staff groups (nursing vs. non-nursing) exhibited equal confidence gains (nursing gain of 27%, non-nursing gain 22%, p = 0.16), and all confidence gains persisted at six weeks. Conclusion: This interactive, novel, training program significantly improved nursing home staff confidence in managing palliative care situations, and this confidence was sustained at least six weeks after the sessions.

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“…The prevention of inappropriate hospitalizations for NH residents is a complex approach that can only be effective if it is based on multiple synchronized actions ( 25 ). The importance of training ( 27 ), motivation ( 28 ) of NH care teams, implementation of preventive measures, use of the assessment protocol before transferring to the emergency room ( 16 ), taking into account the opinion of the resident, drafting advance directives, and prior discussion with the families are all means which, in fine, help to curb the inappropriate use of emergency rooms. The INTERACT program developed in the United States focused on training the NH care team, but not involving all the levers of action, did not show its effectiveness by decreasing hospitalizations ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

An Innovative Day Hospital Dedicated to Nursing Home Resident: A Descriptive Study of 1306 Residents Referred by their Physicians

Mazières

Romain

Hermabessière

et al. 2018

The Journal of nutrition, health and aging

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BackgroundThe transfer rate of residents from nursing homes (NH) to emergency rooms is high. These transfers are often inappropriate but also potentially avoidable. Recent studies have shown that in terms of methods for training NH teams, proposals for improvement of the healthcare sector must be organized. Given this observation, Gérontopôle de Toulouse (France) opened in October 2015, a responsive day hospital dedicated to NH residents (DH NH). This day hospital is characterized by its vocation, exclusively dedicated to NH residents and its ability to provide patient care within a short period of time.ObjectivesThe purpose of this day hospital is twofold: (1) decrease the rate of inappropriate transfers for NH residents by offering general practitioners and NH teams quick access to expert advice, blood tests and radiological examinations during hospitalizations and care adapted to the characteristics of NH residents; (2) potentially reduce avoidable transfers to emergency rooms and hospitalizations by taking action to prevent acute decompensation in residents, but also for the education and training of NH healthcare teams. This manuscript aims to describe the arrangements put in place and the characteristics of the residents collected after two years of activity.DesignRetrospective descriptive study.SettingGérontopôle of Toulouse, France.Participants1306 residents have been consulted at the DH NH.MeasurementsReferring physicians (treating physicians, coordinating physician or emergency room physicians) send a standardized hospitalization request form to the day hospital by fax or email indicating the reason for the request, specialist opinion(s) desired and additional required examination(s). A gerontological assessment was conducted and anamnesis data was collected for each resident, on the very day of their coming to the DH NH.ResultsIn 2 years, 1306 residents from 120 NHs were sent to the DH NH. The mean age was 86.23 ± 7.05 years and the majority of patients were women (n=941, 72.22%), dependent (median ADL at 2.75, [1.25-4.5]) and malnourished (821, 63.25%). In the 3 months prior to their visit to the day hospital, 668 (57.14%) residents had been hospitalized, and one-quarter (n=336, 25.72%) had been transferred to emergency rooms. The main reasons for hospitalization included assessment of cognitive disorders (n=336, 17.52%), assistance in managing behavioral disorders (n=297, 15.48%) and bedsores and slow wound healing (n=223, 11.63%).ConclusionOur experience over a 2-year period suggests that the DH NH could be a practical response to the problem of inappropriate and avoidable transfers of NH residents to emergency rooms. This innovation could easily be utilized in other hospitals.

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Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates

Cited by 20 publications

References 33 publications

Qualitätsmessung mit Routinedaten in deutschen Pflegeheimen: Eine erste Standortbestimmung

Qualitätsmessung mit Routinedaten in deutschen Pflegeheimen: Eine erste Standortbestimmung

Does an Interactive, Teleconference-Delivered, Palliative Care Lecture Series Improve Nursing Home Staff Confidence?

An Innovative Day Hospital Dedicated to Nursing Home Resident: A Descriptive Study of 1306 Residents Referred by their Physicians

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