A Conceptual Framework for Understanding Interorganizational Relationships Between Nursing Homes and Emergency Departments: Examples From the Canadian Setting

Campo, Michael; Savage, Robert; Mandville-Anstey, SueAnn

doi:10.1177/1527154409357795

Cited by 12 publications

(14 citation statements)

References 32 publications

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“…It is supported by previous research indicating that relationships between ED and RACF staff could be improved by providing information on each others' perspectives (McCloskey, Campo, Savage, & Mandville-Anstey, 2009). It is supported by previous research indicating that relationships between ED and RACF staff could be improved by providing information on each others' perspectives (McCloskey, Campo, Savage, & Mandville-Anstey, 2009).…”

Section: Communication Diffi Cultiessupporting

confidence: 67%

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

O’Connell

Hawkins²,

Considine³

et al. 2013

Contemporary Nurse

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This research aimed to describe the number and type of residents admitted to emergency departments (EDs) over 2 years; and to explore nurses' perceptions of the reasons why residential aged care facility (RACF) residents are referred to EDs. The research objective was addressed in a retrospective exploratory study using data on admissions to EDs from RACFs (N = 3,094) at the participating organisation over a 2-year period, and interview data on seven RACF and four ED nurses' perceptions of the issues involved. Most residents presenting at EDs required urgent medical attention. Major themes identified by RACF and ED nurses included issues related to staff competency, availability of general practitioners, lack of equipment in RACFs, residents and family members requesting referrals, communication difficulties, and poor attitudes towards RACF staff. There is a need to use strategies to detect residents whose conditions are deteriorating and treat them promptly in RACFs.

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Section: Communication Diffi Cultiessupporting

confidence: 67%

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

O’Connell

Hawkins²,

Considine³

et al. 2013

Contemporary Nurse

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“…see [11,16,30]) and much of the literature is limited to one part of the system – the ED. Few focus on pre- and post-hospital transfer services.…”

Section: Discussionmentioning

confidence: 99%

The Older Persons’ Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool

Reid

Cummings

Cooper

et al. 2013

BMC Health Serv Res

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BackgroundOPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-irsc.gc.ca/e/34348.html) study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3).MethodsThe pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing.ResultsResidents were elderly (mean age = 87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings.ConclusionsWhile most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.

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“…While a number of US investigators have reported on transitions for NH residents, in particular NH-ED transitions [24-29], few Canadian studies exist that report on transitions for NH residents [30-32]. We do know that the in-hospital, and in particular ED experience for the frail NH resident is characterized by serious quality and safety concerns [33-36].…”

Section: Introductionmentioning

confidence: 99%

Older Persons’ Transitions in Care (OPTIC): a study protocol

et al. 2012

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BackgroundChanges in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to:1. define successful and unsuccessful elements of transitions from multiple perspectives;2. develop and test a practical tool to assess transition success;3. assess transition processes in a discrete set of transfers in two study sites over a one year period;4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH – ED transitions.Methods/DesignThis is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases).DiscussionKey to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.

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A Conceptual Framework for Understanding Interorganizational Relationships Between Nursing Homes and Emergency Departments: Examples From the Canadian Setting

Cited by 12 publications

References 32 publications

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

The Older Persons’ Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool

Older Persons’ Transitions in Care (OPTIC): a study protocol

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