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

Abstract

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.

Nursing home nurses’ experiences of resident transfers to the emergency department: no empathy for our work environment difficulties

“…This result suggests that interventions to improve Chinese NH resident transfers to the ED should be both family and resident‐centred (Cummings et al . ). One such intervention could be to establish a real‐time telehealth system that simultaneously connects family members, the hospital and the NH (Wu et al .…”

“…However, ED staff perceived NH residents as problematic and unworthy of health care (McCloskey & van den Hoonaard , Cummings et al . , Robinson et al . ) and often decided to triage scarce manpower and bed resources to patients with a better prognosis (McCloskey & van den Hoonaard ).…”

Improving care for residents in long term care facilities experiencing an acute change in health status

“…These completed abstraction forms will then be reviewed by the physician panel. Specifically, we will use a previously developed six-point scale to determine the degree to which the ED transfer was the result of suboptimal care provided by community paramedicine [ 36 ].…”

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

“…Consistent with Tri-Council policy, a waiver of consent was obtained to enroll all NH residents experiencing emergency transfers [21]. In BC, a full waiver of consent was obtained from the regional health authority for transferred residents in nine of the 12 participating NHs.…”