Factors influencing decision-making processes for unwell residents in residential aged care: Hospital transfer or Residential InReach referral? (original) (raw)
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Transitions from hospital to residential aged care in Australia
Australasian Journal on Ageing, 2009
Aim: To investigate movement of people from hospital into residential aged care. Methods: An innovative record linkage method was implemented to create a national database to investigate transitions from hospital into aged care. Results: In 2001-2002, 3.2% of hospitalisations for people aged 65+ ended with admission into residential aged care. A further 5.5% were for people already living permanently in care. Nationally, more people were admitted into permanent care from hospital than from the community. Factors important in predicting admission to aged care from hospital included length of hospital stay, diagnoses, region of usual residence and hospital jurisdiction. Conclusion: Individually, national hospital and aged care datasets do not provide adequate information on movement between the sectors. Linking the data allowed the first national investigation into movement from hospital into aged care. Results indicate the importance of investigating interactions of service provision (both supply and demand driven) at the local level.
BMJ Open
ObjectivesTo use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care.DesignThe Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective.ResultsThree overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discover...
Australasian Journal on Ageing, 2019
Objectives: Nursing staff in residential aged care facilities (RACF)s often make decisions about the transfer of residents to the emergency department (ED). This paper describes the protocol of a study that aims to understand decision-making process utilised by RACF registered nurses (RNs) and to explore the perceptions of RNs about the decision and communication process between RACF and ED. Methods: The proposed mixed-method study will survey and interview RACF RNs to understand their decision to transfer a resident and collect information about older people referred to the ED. Data collection will involve telephone survey, ED information system (EDIS) data and semistructured interviews. Results: The project outcomes will provide an understanding of existing ED service provision, communication between facilities and the reasons for transfer of older person to ED. This may inform redesign in communication processes between the ED and local RACFs and outreach care from the ED to RACFs. K E Y W O R D S community health, decision-making, emergency services, medical, health services for the aged, nurses, residential facilities How to cite this article: Gurung A, Broadbent M, Bakon S, et al. Understanding registered nurse decision-making, communication and care delivery between emergency departments and residential aged care facilities: A research protocol.
Hospital admissions from nursing homes: a qualitative study of GP decision making
British Journal of General Practice, 2012
Background Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions Aim To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital. Design and setting A purposive sample of 21 GPs from two counties in the South of England.
Journal of Clinical Nursing, 2011
Aims and objectives. To explore current practice and opportunities to improve practice in decision-making about transfer of nursing home residents to hospital. Background. Nursing home staff are often faced with the decision of whether to send a resident to hospital for medical treatment. While many residents will benefit from going to hospital, there are also several risks associated with this. This study sought to add to the existing body of research on this issue by seeking the views of nursing home managers, who are the persons most frequently involved in making these decisions. Design. Qualitative design using purposive, quota sampling. Method. Qualitative interviews with 41 nursing home managers from southwestern Sydney, Australia. Results. Factors affecting the decision to transfer a resident to hospital include acuteness of their condition; level and style of medical care available; role of family members; numbers, qualifications and skills mix of staff; and concern about criticism for not transferring to hospital. Two factors that have not featured as strongly in previous research are the roles of advance care planning and support from local hospital and community health services. Conclusion. While transferring a nursing home resident to hospital is often necessary, there are many situations where they could be cared for in the nursing home; therefore, avoid complications associated with being in hospital. Apart from a range of factors already identified in the literature, this study has highlighted the important role that advance care planning and support from local health services can play in reducing unnecessary transfers to hospital. Relevance to clinical practice. There are several strategies that nursing homes and local health authorities can adopt to promote advance care planning and build better support systems between the two sectors, thereby reducing the numbers of residents who need to be transferred to hospital for their health care.
Age and Ageing, 2012
Background: residents of aged care are old, frail and frequently require hospital management of intercurrent illness, but hospital outcomes are poor. Objective: to identify the impact of an interdisciplinary care model on medical inpatients admitted from residential aged care (RAC). Design: pre-planned subgroup analysis of controlled trial. Setting: general medical units of a teaching hospital in Brisbane, Australia. Subjects: consecutive patients aged over 65 admitted from RAC (n = 189) or the community (n = 815). Methods: all admitted general medical patients were allocated by existing cyclical roster to control (usual care) or intervention units (interdisciplinary care consisting of improved allied health staffing, consistent teams, daily team meetings and early discharge planning). Patient characteristics and outcomes of care were compared between RAC and community subgroups. In the RAC subgroup, outcomes were compared between the control and intervention groups. Results: patients admitted from RAC had much higher in-hospital mortality (13 versus 6%) and 6-month mortality (35 versus 17%) than those from community. RAC residents receiving the intervention had a significant reduction in in-hospital mortality (4 versus 22% P < 0.001) sustained at 6 months (28 versus 44% P = 0.02). Conclusions: poor hospital outcomes for RAC residents may reflect prevailing models of inpatient care.
Age and Ageing
Background care home residents aged over 65 have disproportionate rates of emergency department (ED) attendance and hospitalisation. Around 40% attendances may be avoidable, and hospitalisation is associated with harms. We synthesised the evidence available in qualitative systematic reviews of different stakeholders’ experiences of decisions to transfer residents to the ED. Methods six electronic databases, references and citations of included reviews and relevant policy documents were searched. Reviews of qualitative studies exploring factors that influenced care home staff, medical practitioners, residents’ family or residents’ experiences and factors influencing decisions to transfer residents to the ED were included. Thematic analysis was used to synthesise findings. Results six previous reviews were included, which synthesised the findings of 34 primary studies encompassing 152 care home residents, 283 resident family members or carers and 447 care home staff. Of the primary st...