Fractured Care: A Window Into Emergency Transitions in Care for LTC Residents With Complex Health Needs

Abstract

Objective: For long-term care (LTC) residents, transfers to emergency departments (EDs) can be associated with poor health outcomes. We aimed to describe characteristics of residents transferred, factors related to decisions during transfer, care received in emergency medical services (EMS), ED settings, outcomes on return to LTC, and times of transfer segments along the transition. Method: We prospectively followed 637 transitions to an ED in British Columbia and Alberta, Canada, over a 12-month period. Data were captured through an electronic Transition Tracking Tool and interviews with health care professionals. Results: Common events triggering transfer were falls (26.8%), sudden change in condition (23.5%), and shortness of breath (19.8%). Discrepancies existed between reason for transfer, EMS reported chief complaint, and ED diagnosis. Many transfers resulted in resident return directly to LTC (42.7%). Discussion: Avoidable transfers may put residents at risk of receiving inappropriate care. Standardized communication strategies to highlight changes in resident condition are warranted.

Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method

“…Furthermore, (c) quality of care could be improved, for example, via increased continuity of care and improved pain management. For example, the RNX will support care workers in acute care situations by guiding them as necessary to contact the physician, by preparing transfers, by sharing crucial clinical information about the resident's needs and functional capacities and by keeping contact with the hospital during hospitalizations (Cummings et al., 2020). Depending on the existing skill set on the unit, RNX could also handle the physician visit or initiate contact with a physiotherapist to align care goals.…”

Quality Indicators for Older Persons’ Transitions in Care: A Systematic Review and Delphi Process

“…Of the QIs identified in this review, many can be used to monitor and improve transitions to and from EDs and in-patient settings, particularly pertaining to timeliness and safety in the process of care delivery. Target wait times from ED arrival to disposition for older adults are often not met and when older adults are hospitalized, they are at high risk of experiencing adverse events such as medicationrelated errors and in-hospital death (Cummings et al, 2020;Riaz & Brown, 2019;Tisminetzky et al, 2019). Although many older patients are discharged back to the community, they experience high rates of repeat ED visits and unplanned hospitalizations largely attributed to unresolved problems and limited discharge planning (Ahn, Hussein, Mahmood, & Smith, 2020;Brennan, Chan, Killeen, & Castillo, 2015;Doupe et al, 2012).…”

“…Although data are available for care delivery within continuing care settings (such as RAI-Minimum Data Set [MDS] 2.0 nursing home data), (Estabrooks, Knopp-Sihota, & Norton, 2013) we found a lack of rigorously developed indicators for processes leading up to a decision to transfer and for the initial patient transfer process from continuing care settings. Despite existing research regarding trigger events leading to transfer to acute care services for older persons, only one feasible QI related to a trigger event (falls) was identified and it was only captured as an element of LTC admission, not of transfer from continuing care to acute care services (Cummings et al, 2020;Dwyer, Stoelwinder, Gabbe, & Lowthian, 2015). Other QI reviews on care delivery for older adult populations report that most indicators focus on examinations and treatment for a specific disease, although limited measures are available to monitor safety and quality concerns where care services intersect (Joling et al, 2018;Laugaland, Aase, & Barach, 2011).…”

An Assessment of Handover Culture and Preferred Information in the Transitions of Care of Elderly Patients

“…To our knowledge, our study is the first which has sought the opinions of an interdisciplinary HCP group as well as PFAs. An interdisciplinary approach and patient involvement have been advocated for in the past but there appears to be a paucity of published literature which has involved PFAs in this area [3,14]. Furthermore, interdisciplinary co-design and implementation of transfer protocols have been demonstrated to improve communication [19].…”

“…There has been a recent call for the creation of standardized, “receiver-driven” handover protocols [13]. With respect to the LTC elderly population, it has been recommended that standardized communication protocols be implemented with multidisciplinary input [14]. In this project, we performed a survey of key stakeholders involved in the transitions of care of elderly patients between LTC facilities and the ED.…”