Guide on hospital transfers for nursing home residents and their families

Photo: Elderly woman and caregiver

'Go to the Hospital or Stay Here? A Decision Guide for Patients and Families' receives PCORI Award; © Florida Atlantic University

The Christine E. Lynn College of Nursing at Florida Atlantic University (FAU) recently received a $50,000 Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI) for a program to widely disseminate an evidence-based decision guide they've developed for nursing home residents and their families titled "Go to the Hospital or Stay Here? A Decision Guide for Patients and Families."

Hospitalization of nursing home residents are common and often result in complications and excessive costs. Nearly 1 in 4 people admitted to a skilled nursing facility from acute care are rehospitalized within 30 days at a cost of $14.3 billion annually. It is estimated that as many as two-thirds of those hospitalizations are avoidable. It's been suggested that the role of family members of nursing home residents heavily influences decisions related to transferring residents to the hospital. In order to make optimal decisions concerning hospitalizations, nursing home residents and their families need to have clear information about their treatment options and health conditions.

"Hospitalization carries many risks including falls, pressure ulcers, infections, decline in function, and disorientation," said Ruth Tappen, Ed.D., Christine E. Lynn Eminent Scholar and a professor in FAU's College of Nursing. "One way that we can effectively inform patients and facilitate the decision-making process is by using tools that support the exchange of information between the health care provider and the patient."

In a parent study, Tappen and colleagues identified the need for more effective decision support tools to help avoid two of the three most frequent reasons given by nursing home staff for avoidable or potentially avoidable hospital transfers: the insistence by the resident or family member for the transfer, and a communication gap between nursing staff, primary care providers and families.

"Even when the resident has a palliative condition that can be treated in the nursing home, there are some instances where family members may still demand hospitalization," said Tappen. "They might just be uninformed about the actual prognosis of the resident or simply unaware of the treatment options available in the nursing home. This is why tools like the guide we have developed are crucial to enhance communication and information sharing between all parties involved in the decision-making process."

The information package developed at FAU includes the guide, a smaller tri-fold and an implementation kit that will be available in both paper and electronic forms. With the PCORI funding award, FAU's College of Nursing will complete the translation of the guide and other materials into the top five languages spoken in the United States including English and Spanish. FAU will work with the American Health Care Association and Leading Age as well as consumer and professional organizations to enhance the distribution of the guide. Using this outreach effort will enable Tappen and her colleagues to reach their target population, which includes the residents themselves who typically have little or no internet access.

"Our ultimate goal with this program is to put the information contained in our guide into the hands of as many nursing home residents and their families as possible and to both improve quality of care and avoid unnecessary hospitalizations and associated costs," said Tappen.; Source: Florida Atlantic University

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