Vom Pflegeheim ins Krankenhaus und wieder zurück… Eine multimethodale Analyse von Krankenhaustransporten aus Alten- und Pflegeheimen

Kada, Olivia; Brunner, Eva; Likar, Rudolf; Pinter, Georg; Leutgeb, Ines; Francisci, Nina; Pfeiffer, B. H.; Janig, Herbert

doi:10.1016/j.zefq.2011.03.023

Cited by 34 publications

(26 citation statements)

References 26 publications

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“…Some authors defined inappropriate ED transfers as preventable transfers; a transfer that may have been avoided if an existing condition would have been managed optimally in the NH at an earlier stage or when adequate prevention would have avoided its initial presentation [2, 27, 29, 45, 47]. Other authors defined inappropriateness by using a list of symptoms and conditions that were frequently associated with potentially preventable ED visits and hospitalisations [18, 27, 29, 31, 33, 44–46, 48]. On the other hand, some authors defined appropriate ED admissions using a list of symptoms and conditions certainly needing acute medical attention [5, 18, 45, 46].…”

Section: Resultsmentioning

confidence: 99%

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

et al. 2019

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BackgroundElderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.MethodsSystematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract.ResultsSeventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital.ConclusionsThe definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

et al. 2019

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“…Zustand und Lebensqualität verschlechtern sich; die Patienten sind häu-figer von externen Hilfen abhängig [6,21]. Die Vorstellung in einer Notaufnahme mit nicht auf geriatrische Bedürfnisse abgestimmten Strukturen und Prozessen ist für die Patienten als Hochrisikosituation zu sehen und geht in der Folge mit einer Verschlechterung der Selbsthilfefä-higkeit und erhöhten Mortalität einher [6].…”

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Der geriatrische Patient in der Notaufnahme

Singler

Dormann

Dodt

et al. 2016

Notfall Rettungsmed

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“…Of NHRs’ transfers to hospitals, around 40% are considered avoidable [ 9 ] of transfers to emergency departments even up to 55% [ 10 ]. In Germany, 32 of 100 NHRs were hospitalised for ambulatory-sensitive reasons during a year, which means, that these hospitalisations are considered to be avoidable by timely prevention or treatment by outpatient health services ([ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial

Müller

Hesjedal-Streller

Fleischmann

et al. 2020

Trials

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Background In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention. Methods This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed. Discussion This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers. Trial registration ClinicalTrials.gov NCT03426475. Initially registered on 7 February 2018.

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Vom Pflegeheim ins Krankenhaus und wieder zurück… Eine multimethodale Analyse von Krankenhaustransporten aus Alten- und Pflegeheimen

Cited by 34 publications

References 26 publications

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

Der geriatrische Patient in der Notaufnahme

Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial

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