Who Doesn’t Come Home? Factors Influencing Mortality Among Long-Term Care Residents Transitioning to and From Emergency Departments in Two Canadian Cities

Abstract

Residents of long-term care (LTC) whose deaths are imminent are likely to trigger a transfer to the emergency department (ED), which may not be appropriate. Using data from an observational study, we employed structural equation modeling to examine relationships among organizational and resident variables and death during transitions between LTC and ED. We identified 524 residents involved in 637 transfers from 38 LTC facilities and 2 EDs. Our model fit the data, (χ2 = 72.91, df = 56, p = .064), explaining 15% variance in resident death. Sustained shortness of breath (SOB), persistent decreased level of consciousness (LOC) and high triage acuity at ED presentation were direct and significant predictors of death. The estimated model can be used as a framework for future research. Standardized reporting of SOB and changes in LOC, scoring of resident acuity in LTC and timely palliative care consultation for families in the ED, when they are present, warrant further investigation.

The Application of Structural Equation Modeling in Nursing Research: A Bibliometric Analysis

“…The network analysis of authors could help to identify influential researchers and collaborations between authors related applying SEM in nursing researches. Lanschinger H, Estabrooks CA, Brunetto Y, Lee S, and Willett WC were important authors of publications in applying SEM in nursing researches (Boamah et al, 2018;Brunetto et al, 2016;Lee, 2021;Tabung et al, 2016;Tate et al, 2021). Stampfer MJ, Lanschinger H, Spiegelman D, Inouye SK and Hu FB are of high citations, indicating that they also contribute a lot to this field (Grodstein et al, 2000;Hu et al, 1999;Inouye et al, 1993).…”

Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

“…To determine total domain scores, we summed the number of indicators each transition met within a domain and divided this sum by the total number of indicators within that domain (figure 1). Indicators that related to EMS return trips and LTC on return were not applied to transitions during which the resident died during transition (N=63) 30. A timeliness measure related to ED length of stay was not applied to seven of these cases where residents died within the ED.…”

“…Indicators that related to EMS return trips and LTC on return were not applied to transitions during which the resident died during transition (N=63). 30 A timeliness measure related to ED length of stay was not applied to seven of these cases where residents died within the ED.…”