Physician's perception leading to the transfer of a dying nursing home resident to an emergency department: A French qualitative study

Kouyoumdjian, Valentin; Perceau-Chambard, Élise; Sisoix, Corinne; Filbet, Marilène; Tricou, Colombe

doi:10.1111/ggi.13600

Cited by 15 publications

(15 citation statements)

References 19 publications

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“…Concerning the communication among the staff we could see a larger discrepancy. Whereas the GPs rated this measure important, which was also shown in two studies in France [54] and the UK [34], the majority of the responding NHs perceived no problem here.…”

Section: Discussionsupporting

confidence: 71%

“…Physicians put the emphasis on NH-related factors and rated most importantly the improvement of the staffing capacity in NHs. Physicians' concerns about understaffing have also been identified in other studies in England [48] and France [54]. In the same way, the staffing level plays a key role in the facility staff decision-making [34,46].…”

Section: Discussionmentioning

confidence: 76%

“…Such disagreements can be caused by communication difficulties between nurses and physicians and uncertain responsibilities which are known to contribute to acute hospital transfers of NH residents [46]. Sharing information about a resident's condition between nurses [33,34,54] and between nursing staff and GP [33,34,37,41,46,48] has the potential to prevent inappropriate hospital transfers. This is supported by our surveys in which both groups rated the interprofessional communication highly important.…”

Section: Discussionmentioning

confidence: 99%

“…6). Drawing from the existing literature [27,33,34,46,54] and insights from interviews with nurses and GPs in the scope of the HOMERN project we listed the following eight measures: (1) better communication between nursing staff, (2) better communication between nursing staff and GP, (3) better GP's care/availability, (4) better medical specialist's care/availability (5) better availability of (medical) resources in the NH (e.g., catheters, rapid diagnostic tests, drugs), (6) more nursing staff, (7) qualification activities for nursing staff, and (8) explicit advance directives (ADs). Besides, the respondents were given the opportunity stating a measure not mentioned before (free-text).…”

Section: Content Of the Questionnairementioning

confidence: 99%

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Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement. Methods: Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests. Results: We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492). Conclusions: A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Content Of the Questionnairementioning

confidence: 99%

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Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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“…The third part dealt with possible areas for reducing the number of hospital transfers which the GPs and NH staff should again rate using a 5-point Likert scale ranging from '0 = no relevance' to '4 = high relevance'. Drawing from the existing literature [27,33,34,46,53] and insights from interviews with nurses and GPs in the scope of the HOMERN project we listed the following eight measures: (1) better communication between nursing staff, (2) better communication between nursing staff and GP, (3) better GP's care/availability, (4) better medical specialist's care/availability (5) better availability of (medical) resources in the NH, (6) more nursing staff, (7) qualification activities for nursing staff, and (8) explicit advance directives (ADs). Besides, the respondents were given the opportunity stating a measure not mentioned before (free-text).…”

Section: Content Of the Questionnairementioning

confidence: 99%

Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

Fassmer

Pulst

Spreckelsen

et al. 2020

Preprint

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.Methods: Two cross-sectional studies were conducted as surveys among 1,121 GPs in the German federal states Bremen and Lower Saxony and staff from 1,069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.Results : We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p<0.0001; emergency department visits: 39.9% vs. 20.9%, p<0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p=0.0009). Both groups rated almost all potential measures for improvement differently (p<0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p=0.1492).Conclusions : A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Notfallsituationen und Krankenhauszuweisungen in Pflegeeinrichtungen – ein Scoping-Review zu Begleitumständen und versorgungsrelevanten Maßnahmen

Bretschneider

Poeck

Freytag

et al. 2022

Bundesgesundheitsbl

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Zusammenfassung Hintergrund Pflegeheimbewohner:innen werden häufiger hospitalisiert als nicht institutionalisierte Gleichaltrige. Eine Vielzahl an Rettungsdiensteinsätzen und Krankenhauszuweisungen wird als potenziell vermeidbar eingeordnet. Ziele der Arbeit Zuweisungsbegünstigende Begleitumstände bei Notfallsituationen in Pflegeeinrichtungen sowie Ansätze zur Reduktion von Krankenhauszuweisungen sollen identifiziert werden, um die Komplexität der Versorgungsprozesse und Handlungsperspektiven aufzuzeigen. Material und Methoden Scoping-Review mit Analyse aktueller Original- und Übersichtsarbeiten (2015–2020) in den Datenbanken PubMed, CINAHL sowie per Handsuche. Ergebnisse Aus 2486 identifizierten Studien wurden 302 Studien eingeschlossen. Verletzungen, Frakturen, kardiovaskuläre und respiratorische Erkrankungen sowie Infektionskrankheiten sind die häufigsten retrospektiv erfassten Diagnosegruppen. Hinsichtlich der einweisungsbegünstigenden Umstände konnten verschiedene Aspekte identifiziert werden: bewohnerbezogene (z. B. Multimorbidität, fehlende Patientenverfügungen), einrichtungsbezogene (u. a. Personalfluktuation, Unsicherheiten), arztbezogene (z. B. mangelnde Erreichbarkeit, erschwerter Zugang zu Fachärzt:innen) und systembedingte (z. B. eingeschränkte Möglichkeiten zur Diagnostik und Behandlung in Einrichtungen). Verschiedene Ansätze zur Verminderung von Krankenhauszuweisungen sind in Erprobung. Diskussion Vielfältige Begleitumstände beeinflussen das Vorgehen in Notfallsituationen in Pflegeeinrichtungen. Interventionen zur Reduktion von Krankenhauszuweisungen adressieren daher u. a. die Stärkung der Kompetenz des Pflegepersonals, die interprofessionelle Kommunikation und systemische Ansätze. Ein umfassendes Verständnis der komplexen Versorgungsprozesse ist die wesentliche Grundlage für die Entwicklung und Implementierung effektiver Interventionen.

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Physician's perception leading to the transfer of a dying nursing home resident to an emergency department: A French qualitative study

Cited by 15 publications

References 19 publications

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Perspectives of General Practitioners and Nursing Staff on Acute Hospital Transfers of Nursing Home Residents in Germany: Results of two cross-sectional Studies

Notfallsituationen und Krankenhauszuweisungen in Pflegeeinrichtungen – ein Scoping-Review zu Begleitumständen und versorgungsrelevanten Maßnahmen

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