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

Abstract

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.

Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods

“…9 The studies chosen focused on the decision-making process around hospital transfers, perceptions of hospital avoidance, the transfer experience, including experiences around coordination and communication. Three studies were conducted in the United States, 9,19,20 two in Australia, 17,18 and one each in Sweden 24 and Canada. 16 Participants ranged from nursing home residents, aged care nurses, hospital nurses, physicians, physicians assistants, nursing home managers and supervisors; however, responses from nurses working in nursing homes, including nurses who were managers or supervisors, were the only responses considered for the review.…”

“…16,18,20 One disturbing finding was the lack of respect paid to nursing home nurses by other health care professionals. In one case, an ambulance officer refused to take a resident to hospital because he disagreed with the nurse that the resident required hospitalization.…”

“…Nursing homes are not "miniature hospitals" 20 but limited access to resources such as relevant diagnostic equipment, as noted in some facilities 9,18,20 can hamper nurses' decision-making capabilities. 20 In particular, lack of access to laboratory results and electrocardiograms (ECGs) can contribute to over-hospitalization.…”

“…16,19,20,24 Communication training would also help to address the lapses in communication, both verbal and written, that were identified between nursing homes and EDs. 18,24 Instruction on how to effectively communicate a resident's situation is needed. 14 The introduction of standard communication tools, such as the use of Situation, Background, Assessment, Recommendation (SBAR), would be another step toward improving communication practices.…”

“…31 Nurses believed training and access to equipment would prevent some residents from being transferred to hospital. 18 Clinical practice tools included in hospital avoidance programs, such as a laminated resource guides that list critical vital signs and laboratory results, should be added to the armamentarium of resources available. 8 Nursing staff in facilities that utilize these types of decision-support tools report increased confidence in their assessment and reporting of deteriorating residents.…”