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Mind the gap: Organizational factors related to transfers of older people between nursing homes and hospital care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care.

The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners.

Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1120
Keyword [en]
hospitalizations, advance care planning, emergency service, patient admission, nursing homes
National Category
Clinical Medicine
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-259342ISBN: 978-91-554-9284-7 (print)OAI: oai:DiVA.org:uu-259342DiVA: diva2:843829
Public defence
2015-09-18, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-08-27 Created: 2015-07-31 Last updated: 2016-08-17Bibliographically approved
List of papers
1. Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement
Open this publication in new window or tab >>Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 4, 886-895 p.Article in journal (Refereed) Published
Abstract [en]

Aim:

To investigate registered hospital and nursing home nurses' experiencesof coordination and communication within and between care settings when olderpersons are transferred from nursing homes to hospital and vice versa.

Background:

It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.

Design:

A descriptive study design with a qualitative approach was used.

Methods:

In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.

Results:

Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospitalregistered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursinghome registered nurses suggested increased collaboration to understand each other's work situation better.

Conclusion:

Communication and coordination among hospital andnursing home registered nurses need to be furthered improved. Registered nurses'coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursingcare and unnecessary transfer and admission to hospital.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-186141 (URN)10.1111/j.1365-2648.2012.06077.x (DOI)000316285400014 ()
Available from: 2012-11-28 Created: 2012-11-28 Last updated: 2017-12-07
2. The frequency of and reasons for acute hospital transfers of older nursing home residents
Open this publication in new window or tab >>The frequency of and reasons for acute hospital transfers of older nursing home residents
2013 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 1, 115-120 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

 

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Avoidable hospitalization, emergency department, hospital admission, care provider
National Category
Geriatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-207769 (URN)10.1016/j.archger.2013.08.002 (DOI)000325984500020 ()24016467 (PubMedID)
Available from: 2013-09-18 Created: 2013-09-18 Last updated: 2017-12-06Bibliographically approved
3. Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates
Open this publication in new window or tab >>Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates
2017 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 1, 41-48 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department.

Design: Explorative.

Method: In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department. Data were analysed by non-parametric tests and basic content analysis.

Results: All nursing homes in the highest transfer rate group and one in the lowest transfer rate group were run by private for-profit providers. Compared with the low group, the high group had fewer updated advance care plans and the RNs interviewed had less work experience in care of older people and less training in care of persons with dementia. There was no difference in nursing home size or staff/resident ratio. The RNs described similar possibilities to provide palliative care, medical equipment and perceived medical support from GPs.

Keyword
advance care planning, avoidable hospitalization, geriatric nursing, hospital admission, nursing homes, organization and administration
National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:uu:diva-259340 (URN)10.1002/nop2.68 (DOI)000390566200005 ()
Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04Bibliographically approved
4. General practitioners' experiences as nursing home medical consultants
Open this publication in new window or tab >>General practitioners' experiences as nursing home medical consultants
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, 37-44 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To describe general practitioners' experiences of being the principal physician responsible for a nursing home.

METHOD:

Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation.

RESULT:

Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

CONCLUSION:

The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems.

Keyword
Advance care planning, general practitioners
National Category
Nursing
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-300896 (URN)10.1111/scs.12310 (DOI)000394988700004 ()
Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2017-04-19Bibliographically approved

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