Do Gerontology Nurse Specialists Make a Difference in Hospitalization of Long‐Term Care Residents? Results of a Randomized Comparison Trial

Abstract

Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.

Decisions to Transfer Nursing Home Residents to Emergency Departments: A Scoping Review of Contributing Factors and Staff Perspectives

“…Development of safe intervention protocols to treat common acute conditions affecting the NH resident population can aim resources at programs to be piloted, measured, and funded if they demonstrate a significant effect on ED transfers. Some early interventions include point-of-care testing and building partnerships with community diagnostic organizations to expedite treatment, access to clinical nurse specialists, 36 NPs, 37 communication protocols for handover of information, 38 telemedicine, 39 and symptom alert systems for front-line NH care aide staff. 40 As more than 50% of NH-ED transfers lead to hospital admissions, interventions to reduce ED admissions are highly relevant.…”

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

“…Drawing on models such as the Gold Standards Framework in Care Homes (GFSCH)36 in the UK, and the residential aged care integration programme (RACIP)37 study (involving gerontology ARC outreach) in New Zealand, as well as results from the present study, the new model includes clinical coaching, and role modelling of both elements are shown to be successful in sustaining knowledge transfer 38. Staff in the current study indicated difficulty identifying when a palliative approach should be initiated.…”

Do More with Less

“…Given this context and future expectations of an increasingly older U.S. demographic, it is critical that geriatric models of care consider care and cost‐effectiveness outcomes equally as we address “doing more with less.” Contributing to our knowledge at this critical junction are the results presented by Boyd and colleagues in this month's Journal of the American Geriatrics Society . This group specifically examined whether the use of advanced practice nurses (APNs) influenced rates of hospitalization in 29 New Zealand residential aged care (RAC) facilities.…”

“…This editorial describes the environment in which we are implementing geriatrics models of care. We will provide some reflections on the article by Boyd and colleagues in this month's Journal of the American Geriatrics Society , and we will note how this study compares with prior descriptions of the use of advanced practice nurses in long‐term care settings. We will conclude with some ideas about strategies to do more with less.…”