scholarly journals Paramedics’ Perspectives on the Hospital Transfers of Nursing Home Residents—A Qualitative Focus Group Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3778
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Nursing Home ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Urinary Catheter ◽  
Nursing Home Residents ◽  
Point Of View ◽  
Focus Group Study ◽  
Professional Groups ◽  
Catheter Complications ◽  
Ed Visits

Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). Little is known about the perspectives of emergency medical services (EMS) which are responsible for hospital transports. The aim of this study was to explore paramedics’ experiences with transfers from nursing homes (NHs) and their ideas for possible interventions that can reduce transfers. We conducted three focus groups following a semi-structured question guide. The data were analyzed by content analysis using the software MAXQDA. In total, 18 paramedics (mean age: 33 years, male n = 14) participated in the study. Paramedics are faced with complex issues when transporting NHRs to hospital. They mainly reported on structural reasons (e.g., understaffing or lacking availability of physicians), which led to the initiation of an emergency call. Handovers were perceived as poorly organized because required transfer information (e.g., medication lists, advance directives (ADs)) were incomplete or nursing staff was insufficiently prepared. Hospital transfers were considered as (potentially) avoidable in case of urinary catheter complications, exsiccosis/infections and falls. Legal uncertainties among all involved professional groups (nurses, physicians, dispatchers, and paramedics) seemed to be a relevant trigger for hospital transfers. In paramedics’ point of view, emergency standards in NHs, trainings for nursing staff, the improvement of working conditions and legal conditions can reduce potentially avoidable hospital transfers from NHs.

scholarly journals Paramedics's perspectives on hospital transfers of nursing home residents - a qualitative focus group study

2019 ◽  
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Health Status ◽  
Qualitative Study ◽  
Focus Groups ◽  
Emergency Medical Services ◽  
Nursing Staff ◽  
Transfer Process ◽  
Nursing Home Residents ◽  
Point Of View

Abstract Background: Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). These transfers are often considered avoidable and can have negative effects on residents’ health status. Emergency medical services (EMS) are an important linking profession between nursing homes (NHs) and hospitals and responsible for transports. So far, little is known about the perspectives of paramedics in this context. The aim of this qualitative study is to explore how paramedics experience hospital transfer process of NHRs and how hospitalizations could be avoided from their point of view. Methods: A qualitative study with three focus groups was conducted with paramedics. The focus groups followed a semi-structured question guide focusing on issues during transfer process, avoidable hospital transfers and potential interventions which might reduce transfers from NHs. Discussions were audio recorded and transcribed verbatim. Data were analyzed by content analysis using the software MAXQDA. Results: In total, 18 paramedics (mean age: 33 years, male n=14) participated in the focus groups. Paramedics mainly reported about perceived structural reasons (e.g. understaffing or lack of time) in NHs which led to initiation of an emergency call. Paramedics were often faced with poorly organized handovers because of lacking or incomplete information. In many cases, nursing staff was perceived as insufficiently qualified and not well-prepared regarding health status of NHRs. Throughout transfer process, the behavior of all involved professional groups (dispatcher/ambulance control center, nurses, physicians and paramedics) was influenced by legal uncertainties. Paramedics rated hospital transfers as avoidable in case of urinary catheter complications, exsiccosis/infections and partially in case of falls. Emergency standards in NHs, trainings for nursing staff, improvement of working conditions and legal conditions were discussed as potential interventions which could reduce hospital transfers of NHRs. Conclusion: Paramedics are faced with complex issues when transporting a NHR to hospital. According to their point of view staff shortage and legal uncertainties play a relevant role in transfer decisions. Interventions reducing (avoidable) hospital transfers of NHRs have to take these factors into account. Keywords: nursing home residents, hospitalization, hospital admission, patient transfer, referral, transition, emergency department, emergency medical services, decision making, advance care planning

scholarly journals Sex-Specific Differences in Hospital Transfers of Nursing Home Residents: Results from the HOspitalizations and eMERgency Department Visits of Nursing Home Residents (HOMERN) Project

2020 ◽  
Vol 17 (11) ◽  
pp. 3915 ◽  
Author(s):  
Alexander Maximilian Fassmer ◽  
Alexandra Pulst ◽  
Guido Schmiemann ◽  
Falk Hoffmann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Sociocultural Factors ◽  
Transfer Policy ◽  
Hospital Transfer ◽  
Ed Visits ◽  
Multicenter Prospective Study

Nursing home (NH) residents are often transferred to hospital (emergency department (ED) visits or hospital admissions) and this occurs more frequently in males. However, respective reasons are rather unclear. We conducted a multicenter prospective study in 14 northwest German NHs with 802 residents in which NH staff recorded anonymized data between March 2018 and July 2019 for each hospital transfer. Measures were analyzed using descriptive statistics and compared between sexes via univariate logistic regression analyses using mixed models with random effects. Eighty-eight planned transfers (53.5% hospital admissions, 46.5% ED visits) occurred as well as 535 unplanned transfers (63.1% hospital admissions, 36.9% ED visits). The two most common causes for unplanned transfers were deteriorations of health status (35.1%) and falls/accidents/injuries (33.5%). Male transferred residents were younger, more often married; their advance directives were more commonly not considered correctly and the NH staff identified more males nearing the end of life than females (52.9% vs. 38.2%). Only 9.2% of transfers were rated avoidable. For advance directive availability and NH staff’s perceptions on transfer conditions, we found marked inter-facility differences. There might be sociocultural factors influencing hospital transfer decisions of male and female nursing home residents and facility characteristics that may affect transfer policy.

scholarly journals Characteristics of outpatient emergency department visits of nursing home residents: an analysis of discharge letters

2021 ◽  
Author(s):  
Stephanie Heinold ◽  
Alexander Maximilian Fassmer ◽  
Guido Schmiemann ◽  
Falk Hoffmann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Nursing Staff ◽  
Wound Care ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Therapeutic Interventions ◽  
Ed Visits ◽  
Multi Center Study ◽  
Gp Care

Abstract Background Unplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. However, there is little research on what diagnostic and therapeutic measures are performed during visits. Aims We analyzed underlying diagnoses, characteristics and performed medical procedures of unplanned outpatient ED visits by NHR. Methods We conducted a multi-center study of 14 nursing homes (NHs) in northwestern Germany in 03/2018–07/2019. Hospital transfers were documented by nursing staff using a standardized questionnaire for 12 months. In addition, discharge letters were used to collect information about the respective transfer, its reasons and the extend of the medical services performed in the ED. Results A total of 161 unplanned ED visits were included (mean age: 84.2 years; 68.3% females). The main transfer reasons were trauma (59.0%), urinary catheter and nutritional probe problems (overall 10.6%; male NHR 25.5%) and altered mental state (9.9%). 32.9% where discharged without imaging or blood test prior. 67.4% of injured NHR (n = 95) required no or only basic wound care. Catheter-related problems (n = 17) were mainly treated by changing an existing suprapubic catheter (35.3%) and by flushing the pre-existing catheter (29.4%). Discussion Our data suggest that the diagnostic and therapeutic interventions performed in ED, often do not exceed general practitioner (GP) care and many ED visits seem to be unnecessary. Conclusion Better coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits.

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

2020 ◽  
Author(s):  
Alexander Maximilian Fassmer ◽  
Alexandra Pulst ◽  
Ove Spreckelsen ◽  
Falk Hoffmann
Keyword(s):  
Nursing Home ◽  
General Practitioners ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Federal States ◽  
German Federal States ◽  
Cross Sectional Studies

Abstract 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.

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

2019 ◽  
Author(s):  
Alexander Maximilian Fassmer ◽  
Alexandra Pulst ◽  
Ove Spreckelsen ◽  
Falk Hoffmann
Keyword(s):  
Nursing Home ◽  
General Practitioners ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Federal States ◽  
German Federal States ◽  
Cross Sectional Studies

Abstract 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 hospitalisations (NHs: 61.4% vs. GPs: 48.8%; p=0.0009). Both groups rated almost all potential measures for improvement differently (p<0.0001). 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 rated better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups agreed on 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. Particularly, 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.

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

2020 ◽  
Author(s):  
Alexander Maximilian Fassmer ◽  
Alexandra Pulst ◽  
Ove Spreckelsen ◽  
Falk Hoffmann
Keyword(s):  
Nursing Home ◽  
General Practitioners ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Federal States ◽  
German Federal States ◽  
Cross Sectional Studies

Abstract 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.

scholarly journals Nursing Staff Knowledge and Beliefs about Pain in Elderly Nursing Home Residents with Dementia

2007 ◽  
Vol 12 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Sandra MG Zwakhalen ◽  
Jan PH Hamers ◽  
Rieneke HA Peijnenburg ◽  
Martijn PF Berger
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Staff ◽  
Educational Level ◽  
Work Experience ◽  
Pain Treatment ◽  
Nursing Home Residents ◽  
Knowledge And Beliefs ◽  
Pain Prevalence ◽  
Knowledge Deficits

BACKGROUND: Aging is known to be associated with a high prevalence (up to 80%) of persistent pain among residents of nursing homes. However, even with high pain prevalence rates, nursing home residents are at risk for undertreatment. Knowledge deficits and beliefs among nurses influence staff behaviour in pain assessment and management.OBJECTIVES: To develop a psychometrically sound questionnaire and to gather information about knowledge and beliefs of nursing staff regarding various aspects of pain in elderly patients with dementia. In addition, the differences among several categories of nurses (based on educational level and work experience) with respect to beliefs about pain were investigated.METHODS: Participants were 123 staff members of psychogeriatric wards in two nursing homes in the Netherlands (mean of 11.4 years of experience). Their results were compared with those of two groups of nurses, one consisting of 25 registered nurse PhD students in nursing science and the other consisting of 20 trainee pain nurse specialists.RESULTS: The main findings indicate that nursing home staff respondents showed knowledge deficits about several aspects of pain, even though they were satisfied about the way pain was assessed and treated at their wards. Specific knowledge deficits were found regarding pain treatment and medication in elderly nursing home residents. Staff educational level seemed to influence their beliefs and knowledge about pain in elderly nursing home patients.

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