Hospitalizations and emergency services (ED) can be painful and costly for residents of nursing homes – in particular those who are seriously altered or in terminal phase. Despite their vulnerability, these people are frequently transferred to hospitals, even if up to 40% of these transfers in the past 25 years are considered potentially preventable by health professionals.
These unnecessary transfers cause not only distress and discomfort for residents and families, but also lead to complications acquired in hospital and additional costs for the health care system. In the United States, hospital transfers of nursing homes contribute considerably to health care costs, especially for Medicare, with around $ 14.3 billion per year.
Most studies on hospitalizations and tours by emergency services among residents of seriously affected nursing homes and in terminal care phase have not examined the diagnoses associated with hospitalizations and potentially avoidable hospitalizations, and they have not seriously altered from terminal residents.
In one of the biggest studies of the genre, researchers from the Schmidt College of Medicine of Florida Atlantic University and Christine E. Lynn College of Nursing, and collaborators, carried out a secondary analysis of the data of 264 nursing homes across the United States to dive into this question.
Using the information of a randomized trial of interventions to reduce the active care transfers program (Interact), the study identifies the specific medical conditions most often linked to hospitalizations, to emergency services and to those considered to be potentially avoidable among residents of seriously altered and terminal nursing homes.
Study results, published in the Journal of the American Medical Directors Associationreveal that among more than 6,000 residents of seriously altered nursing houses, one in three experienced hospitalization – more than a third of which were potentially avoidable. Almost 20% visited the emergency without being admitted and 70% of these visits were deemed avoidable.
Among more than 5,800 terminal residents, hospitalizations and emergency visits were less common but even more likely to be useless. In particular, 80% of emergency visits to this group could have been avoided.
In the seriously altered group, complications of the feeding tubes were the most common reason for these visits, often due to blockages, dislodge or infections. Transfers related to trauma – largely from falls, including head trauma and fractures – were common among terminal residents. And in many cases, deemed to be avoidable.
The study also revealed that certain diagnoses were frequently associated with potentially avoidable hospitalizations. Among the seriously altered residents, urinary tract infections (urinary tract infections), convulsions and low blood pressure (hypotension) were the most common causes of hospital stays that could have been prevented with timely and appropriate care. Urinary infections, in particular, are widely known to be over-diagnosed and over-attracted in nursing care, despite clear clinical directives recommending only treatment when specific results are present.
For terminal residents, pneumonia, urinary tract infections, acute renal failure and heart failure were most often linked to avoidable hospitalizations. Other current diagnoses in the two groups included infections, breathing difficulties and an altered mental state.
“The specific diagnoses that we have identified such as urinary tract infections, pneumonia and sepsis are not surprising, but they highlight certain clear and usable opportunities to improve care. These are conditions that we can better manage in nursing homes, using existing guidelines, care paths and preventive strategies. With the right tools and staff, many health transfresses, many health transfers. »»
Joseph G. Oanslander, MD, principal author of the study and professor, geriatric medicine, Schmidt College of Medicine
Although the definition of “potentially avoidable” varies, the results align with previous studies and highlight the urgent need for proactive care strategies. Many of these hospitalizations could be avoided thanks to lighter care protocols, the management of symptoms in a timely and critical manner, regular planning of advanced care.
Researchers say that ensuring that residents have documented care preferences and that families understand that their options can help avoid crisis decisions and reduce unnecessary transfers. However, obstacles such as the reluctance to register for hospices and financial constraints always pose challenges. The resolution of these problems could improve the quality of life of residents and release hundreds of millions of health care expenses to reinvest in other aspects of care.
“To reduce potentially avoidable hospital transfers, we must strengthen the capacities of nursing home staff and ensure active involvement of medical directors and qualified clinicians,” said Oanslander. “It is not only about individual efforts – this requires the support of nursing homes, supplier organizations and decision -makers. We need daring changes, such as pragmatic national endowment standards, better resources for complex care and payment models that really support high quality care and person for the most vulnerable residents. »»
