Journal of the American Medical Directors Association
Review ArticleDecisions to Transfer Nursing Home Residents to Emergency Departments: A Scoping Review of Contributing Factors and Staff Perspectives
Section snippets
Search Strategy, Data Sources, and Screening
The systematic search used 5 electronic health databases: CINAHL (1984–present), MEDLINE (1948–present), EMBASE (1974–present), SCOPUS, and Proquest Dissertations and Theses Full Test. In addition, a search through the gray literature via Google Scholar, and a hand search of selected bibliographies were completed. A health sciences librarian assisted in the development of the search strategy and database searches. The specific search strategy was based on the following; (“long term care” or
Search Results
Electronic health database searches yielded 850 titles and abstracts, and following removal of duplicates, 783 titles and abstracts were screened using inclusion criteria. Of these, 54 full-text articles met inclusion criteria and were retrieved for full review. Of these, 19 articles were included and underwent quality review and assessment. See Figure 1 for search results. No articles were excluded after quality review, as the purpose of the scoping review was to map the key concepts available
Interpretations of “Avoidable” or “Unnecessary” Transfers from NH to ED
Seven articles provided explicit theoretical definitions of “avoidable” and “unnecessary” transfer, where the terms were used interchangeably.2, 10, 11, 12, 13, 14, 31 The common concepts in these definitions centered on early detection and management in the NH, balance between need and resources, and professional judgment about ability to provide timely, safe, quality care within immediate context of resources, family/resident preferences, and professional competence. No consensus on a
Factors Contributing to NH Residents' Transfer to EDs
Fourteen of the 19 included studies investigated factors that contribute to NH resident transfer to ED. Five categories of factors were identified: nursing, facility/resources, physician/nurse practitioner (NP), NH resident and family, and health system factors (Table 5).
Discussion
Integrated findings of the 19 studies in this scoping review provide a rich understanding of the complex interplay of factors and processes involved in decision-making to transfer a NH resident to an ED. However, a consensus on the definition of “avoidable” or “unnecessary” transfers was not found. Our findings describe factors related to avoidable transfers and some common concepts in definitions (early detection and management in the NH, balance between need and resources, and professional
Conclusion
Reducing the use of acute care services, such as EDs, is essential in maintaining accountability and fiscal responsibility of the health care system, even for NH residents who are a highly vulnerable and frail population. The care needs of NH residents are supportive in nature, but can quickly escalate to encompass complex, multifactorial situations when acute health changes occur. Access to acute care remains an essential aspect of care; however, delivery of these care needs and the
Acknowledgments
We acknowledge L. Slater, a health sciences librarian, who assisted with the initial literature search strategy, and K. Tate, nursing student, who assisted with review calibration.
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The authors declare no conflicts of interest.