Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study
- PDF / 732,043 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 79 Downloads / 176 Views
ORIGINAL ARTICLE
Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study Alexandra Pulst1,2 · Alexander Maximilian Fassmer3 · Guido Schmiemann1,2,4 Received: 11 September 2020 / Accepted: 30 October 2020 © The Author(s) 2020
Abstract Background Emergency department visits and hospital admissions are common among nursing home residents (NHRs) and seem to be higher in Germany than in other countries. Yet, research on characteristics of transfers and involved persons in the transfer decision is scarce. Aims The aim of this study was to analyze the characteristics of hospital transfers from nursing homes (NHs) focused on contacts to physicians, family members and legal guardians prior to a transfer. Methods We conducted a multi-center study in 14 NHs in the regions Bremen and Lower Saxony (Northwestern Germany) between March 2018 and July 2019. Hospital transfers were documented for 12 months by nursing staff using a standardized questionnaire. Data were derived from care records and perspectives of nursing staff and were analyzed descriptively. Results Among 802 included NHRs, n = 535 unplanned hospital transfers occurred of which 63.1% resulted in an admission. Main reasons were deterioration of health status (e.g. fever, infections, dyspnea and exsiccosis) (35.1%) and falls/accidents/ injuries (33.5%). Within 48 h prior to transfer, contact to at least one general practitioner (GP)/specialist/out-of-hour-care physician was 46.2% and varied between the NHs (range: 32.3–83.3%). GPs were involved in only 34.8% of transfer decisions. Relatives and legal guardians were more often informed about transfer (62.3% and 66.8%) than involved in the decision (21.8% and 15.1%). Discussion Contacts to physicians and involvement of the GP were low prior to unplanned transfers. The ranges between the NHs may be explained by organizational differences. Conclusion Improvements in communication between nursing staff, physicians and others are required to reduce potentially avoidable transfers. Keywords Nursing home residents · Hospitalization · Hospital admission · Patient transfer · Emergency department · Decision making Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-020-01751-5) contains supplementary material, which is available to authorized users. * Alexandra Pulst a.pulst@uni‑bremen.de 1
Department for Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
2
Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
3
Department of Health Services Research, School VI, Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114‑118, 26129 Oldenburg, Germany
4
Institute for General Practice, Hannover Medical School, 30625 Hannover, Germany
Introduction Nursing home residents (NHRs) are characterized by multimorbidity and frailty [1]. Compared to com
Data Loading...
