Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study

Abstract

Background Emergency department visits and hospital admissions are common among nursing home residents (NHRs) and seem to be higher in Germany than in other countries. Yet, research on characteristics of transfers and involved persons in the transfer decision is scarce. Aims The aim of this study was to analyze the characteristics of hospital transfers from nursing homes (NHs) focused on contacts to physicians, family members and legal guardians prior to a transfer. Methods We conducted a multi-center study in 14 NHs in the regions Bremen and Lower Saxony (Northwestern Germany) between March 2018 and July 2019. Hospital transfers were documented for 12 months by nursing staff using a standardized questionnaire. Data were derived from care records and perspectives of nursing staff and were analyzed descriptively. Results Among 802 included NHRs, n = 535 unplanned hospital transfers occurred of which 63.1% resulted in an admission. Main reasons were deterioration of health status (e.g. fever, infections, dyspnea and exsiccosis) (35.1%) and falls/accidents/injuries (33.5%). Within 48 h prior to transfer, contact to at least one general practitioner (GP)/specialist/out-of-hour-care physician was 46.2% and varied between the NHs (range: 32.3–83.3%). GPs were involved in only 34.8% of transfer decisions. Relatives and legal guardians were more often informed about transfer (62.3% and 66.8%) than involved in the decision (21.8% and 15.1%). Discussion Contacts to physicians and involvement of the GP were low prior to unplanned transfers. The ranges between the NHs may be explained by organizational differences. Conclusion Improvements in communication between nursing staff, physicians and others are required to reduce potentially avoidable transfers.

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

“…Although treatment options by phone (e.g., between GPs and nursing home residents or the residents' relatives or care nurses) are limited, our study further shows that residents have almost five telephone contacts with GPs per year. Given this finding, and given the expected importance of telephone contacts during a pandemic and in emergency cases [21,22], the importance of telephone contacts is probably greater than expected. Future studies should therefore systematically investigate the role of telephone contacts in the provision of medical care in nursing homes.…”

“…However, in order to draw a complete picture of medical care provision in this setting, it is also necessary to know the number of consultations (i.e., the intensity of medical care) and whether these take place in the nursing home, at a practice, or by telephone. All types of contacts can be relevant for the medical care process (e.g., telephone contacts with GPs during a pandemic and prior to unplanned hospital stays [21,22]). However, previous studies focused particularly on proportions of nursing homes and nursing home residents having contact with physicians [8,10,11,13] but did not systematically investigate the number and types of contact.…”

Nurses’ Perspectives on the Role of Relatives in Emergency Situations in Nursing Homes: a Qualitative Study From Germany

“…In emergency situations, the involvement of relatives is mainly limited to decision making, emergency management and advocacy (23). Nurses try to inform relatives about emergencies as quickly as possible, in order to encourage their involvement from an early stage.…”

Characteristics of outpatient emergency department visits of nursing home residents: an analysis of discharge letters

“…Moreover, the NH staff was asked if the resident was carrying an advance directive (AD) and stated the details by adjusting the emergency advance directive called the patient directive for life sustaining measures (PALMA) [17]. Further information about the decision-making process (final decision maker, previous contact with other health care specialists) and the respective transfer (date and time slot) were gathered and have been published in detail elsewhere [13].…”

“…However, little is known about the underlying pathways that led to the transfer decision and the extent of treatment in ED in those not being hospitalized. Recent data suggests that in two-thirds of the transfers the GP was not involved in the decision making [ 13 ]. Burke et al found that 19.0% of the NHR discharged from the ED did not have any diagnostic testing prior [ 11 ].…”