Strategies to reduce potentially avoidable hospitalisations among long-term care facility residents

Ouslander, Joseph G.

doi:10.1136/bmjqs-2019-009384

Cited by 13 publications

(5 citation statements)

References 36 publications

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“…27,28 Multi-faceted interventions that incorporate support from primary care and aged care, improve advance care planning, increase staff expertise, increase use of telemedicine and become integrated as part of everyday person-centred care may have potential to reduce avoidable hospitalisations in residential aged care. [28][29][30][31] However, further focus should be given to the challenges, barriers and enablers to implementing change, e.g. issues with resources, novel workforce models, competing demands and leadership.…”

Section: Discussionmentioning

confidence: 99%

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Harrison,

Lang,

Eshetie

et al. 2024

Aust. Health Rev.

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Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.

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Section: Discussionmentioning

confidence: 99%

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Harrison,

Lang,

Eshetie

et al. 2024

Aust. Health Rev.

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“…More generally, reducing avoidable transfers from LTC facilities to hospital limits the risk of hospitalrelated iatrogenic harm or adverse events when patients are transferred back to their LTC facility. 23,24 Reducing hospital transfers of LTC residents may also be an important strategy to protect emergency department and ward capacity if there is a surge in admissions related to COVID-19. Our data demonstrate that residents of LTC have higher re admission rates within 30 days than patients typically admit-ted to the general internal medicine service.…”

Section: Discussionmentioning

confidence: 99%

Modelling resource requirements and physician staffing to provide virtual urgent medical care for residents of long-term care homes: a cross-sectional study

Razak

Shin²,

Pogacar

et al. 2020

cmajo

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educing the transfer of residents of long-term care (LTC) facilities to acute care hospitals has been a focus of quality improvement efforts for many years. 1 Coronavirus disease 2019 (COVID-19) has only sharpened this focus. COVID-19 affects older adults, especially those with chronic medical conditions, 2 more severely than younger people, making LTC facilities an especially vulnerable setting for widespread transmission. Early examples of COVID-19 outbreaks in LTC facilities resulted from within-facility spread among residents and health care staff, with high fatality rates among residents. 3 Nosocomial spread of COVID-19 from hospitals to LTC facilities could have dire consequences. 3 A rapidly deployable strategy to reduce safely the frequency of transfers from LTC facilities to

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“…These admissions from nursing homes are primarily caused by infections, falls, dehydration, respiratory diseases and circulatory diseases [ 5 , 6 , 8 ]. Unfortunately, hospital admissions within this vulnerable population are associated with an increased risk of delirium, hospital-acquired infections, functional disability and mortality [ 7 , 9–11 ]. Given these potential complications, hospital admissions might not represent the optimum solution when this population needs emergency care.…”

Section: Introductionmentioning

confidence: 99%

Mobile emergency department care to nursing home residents: a novel outreach service

et al. 2023

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Background Every month, 6% of Danish nursing home residents are admitted to hospital. However, these admissions might have limited benefits and are associated with an increased risk of complications. We initiated a new mobile service comprising consultants performing emergency care in nursing homes. Objective Describe the new service, the recipients of this service, hospital admission patterns and 90-day mortality. Design A descriptive observational study. Model When an ambulance is requested to a nursing home, the emergency medical dispatch centre simultaneously dispatches a consultant from the emergency department who will provide an emergency evaluation and decisions regarding treatment at the scene in collaboration with municipal acute care nurses. Method We describe the characteristics of all nursing home contacts from 1st November 2020 to 31st December 2021. The outcome measures were hospital admissions and 90-day mortality. Data were extracted from the patients’ electronic hospital records and prospectively registered data. Results We identified 638 contacts (495 individuals). The new service had a median of two (interquartile range: 2–3) new contacts per day. The most frequent diagnoses were related to infections, unspecific symptoms, falls, trauma and neurologic disease. Seven out of eight residents remained at home following treatment, 20% had an unplanned hospital admission within 30 days and 90-day mortality was 36.4%. Conclusion Transitioning emergency care from hospitals to nursing homes could present an opportunity for providing optimised care to a vulnerable population and limiting unnecessary transfers and admissions to hospitals.

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Strategies to reduce potentially avoidable hospitalisations among long-term care facility residents

Cited by 13 publications

References 36 publications

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Modelling resource requirements and physician staffing to provide virtual urgent medical care for residents of long-term care homes: a cross-sectional study

Mobile emergency department care to nursing home residents: a novel outreach service

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