Original study
Challenges in Transitional Care Between Nursing Homes and Emergency Departments

These data were presented by Dr Terrell at the 2005 Society for Academic Emergency Medicine (SAEM) Midwest Regional Meeting on September 12, 2005, in Detroit, Michigan, and the American Medical Directors Association 29th Annual Symposium on March 17, 2006, in Dallas, Texas. The data were presented by Dr Terrell at the American Medical Directors Association 29th Annual Symposium on March 17, 2006, in Dallas, Texas.
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Objective

To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents.

Design

Structured focus group interviews.

Participants

Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians.

Setting

Two NHs, 2 EDs, and a county-wide EMS system.

Analysis

Audiotaped discussions were transcribed and analyzed independently by 2 authors.

Results

Themes included barriers to providing high-quality care, data needed when residents are transported in both directions between EDs and NHs, and possible solutions to improve care. Communication problems were the most frequently cited barrier to providing care. Residents are often transported in both directions without any written documentation; however, even when communication does occur, it is often not in a mode that is useable by the receiving provider. ED personnel need a small amount of organized, written information. When residents are released from the ED, NH personnel need a verbal report from ED nurses as well as written documentation. All groups were optimistic that communication can be improved. Ideas included use of (1) fax machines or audiotape cassette recorders to exchange information, (2) an emergency form in residents’ charts that contains predocumented information with an area to write in the reason for transfer, and (3) brief NH-to-ED and ED-to-NH transfer forms that are accepted and used by local NHs and EDs.

Conclusion

The transitional care of NH residents is laden with problems but has solutions that deserve additional development and investigation.

Section snippets

Study Design

This investigation collected data via structured focus group interviews, a qualitative group discussion format. The investigation was approved by the IUPUI/Clarian Institutional Review Board via expedited review, and signed informed consent was obtained from all subjects.

Study Setting and Population

We defined “emergency care of nursing home residents” as care they receive immediately before and during an ED visit and after the ED visit if returned directly to the NH without hospital admission. This care takes place in

Results

The subjects in this investigation included the groups listed in Table 2. We studied 5 different health care provider categories, including a total of 42 subjects, in 7 focus group interviews.

Discussion

The transitional care of NH residents has been increasingly discussed in the medical literature over the past several years.3, 4, 5, 6, 7, 8, 11, 12, 18, 19, 20, 21, 22, 23, 24 Despite the knowledge gained from these studies, providers are still working within a system that remains poorly equipped to provide high-quality emergency care to NH residents. The limited success of seemingly promising interventions, such as the introduction of standardized transfer forms,11, 12 discourages the

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    Dr Terrell is supported by a Dennis W. Jahnigen Career Development Scholars Award, which is funded by the American Geriatrics Society, the John A. Hartford Foundation, and Atlantic Philanthropies, Inc.

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