Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.
University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
J Am Med Dir Assoc. 2022 Aug;23(8):1304-1310.e2. doi: 10.1016/j.jamda.2022.01.063. Epub 2022 Feb 19.
To describe potentially avoidable fall-related transfers to the emergency department (ED), and to identify infrastructure, training needs, and resources deemed appropriate for implementation in nursing homes (NHs) to decrease fall-related transfers to EDs.
A multi-method design, including (1) in-depth case review by an expert panel, (2) structured discussion with NH stakeholders, and (3) appropriateness rating.
Fall-related transfers were identified from the prospective reporting of every unplanned hospital transfer occurring within 21 months, collected during the INTERCARE study in 11 Swiss NHs.
Eighty-one fall-related transfers were rated for avoidability by a 2-round expert panel. NH stakeholders were consulted to discuss key implementable resources for NHs to mitigate potentially avoidable fall-related transfers. A questionnaire composed of 21 contextually adapted resources was sent to a larger group of stakeholders, to rate the appropriateness for implementation in NHs. χ tests were used to assess whether avoidability was associated with an ED visit and to describe transfers. The RAND/UCLA method for appropriateness was used to determine appropriate resources.
One of 4 fall-related transfers were rated as potentially avoidable. A positive association was found between an ED visit and a rating of avoidability (χ (1, N = 81) = 18.0, P < .001). Fourteen resources, including developing partnerships with outpatient clinics to access imaging services and strengthening geriatric expertise in nursing homes through clinical training and advanced nurse practitioners, were rated as appropriate by NH stakeholders for NH implementation to reduce potentially avoidable fall-related ED transfers.
Access to diagnostic equipment, geriatric expertise, and clinical training is essential to reduce fall-related potentially avoidable transfers from NHs. Implementing and supporting advanced practice nurses or nurses in extended roles provides NH directors, policymakers, and health care institutions with the possibility of re-engineering resources to limit unnecessary transfers, which are detrimental for resident quality of care and costly for the health system.
描述可避免的与跌倒相关的紧急部门（ED）转移，并确定在养老院（NH）实施的基础设施、培训需求和资源，以减少与跌倒相关的 ED 转移。
采用多方法设计，包括（1）由专家小组进行深入案例审查，（2）与 NH 利益相关者进行结构化讨论，以及（3）适当性评分。
在瑞士 11 家 NH 进行的 INTERCARE 研究中，通过前瞻性报告，确定了 21 个月内发生的每一次计划外住院转移的与跌倒相关的转移。
由 2 轮专家小组对 81 例与跌倒相关的转移进行了可避免性评估。咨询了 NH 利益相关者，讨论了 NH 缓解潜在可避免的与跌倒相关的转移的关键可实施资源。向更大的利益相关者群体发送了一份由 21 个适应背景的资源组成的问卷，以评估在 NH 实施的适当性。χ 检验用于评估可避免性是否与 ED 就诊相关，并描述转移情况。使用 RAND/UCLA 适当性方法确定适当的资源。
4 例与跌倒相关的转移中有 1 例被评为潜在可避免。ED 就诊与可避免性评分之间存在正相关（χ（1，N=81）= 18.0，P<.001）。14 项资源，包括与门诊诊所合作以获取成像服务，以及通过临床培训和高级执业护士加强 NH 的老年专业知识，被 NH 利益相关者评为适当，可用于 NH 实施，以减少潜在可避免的与跌倒相关的 ED 转移。
获得诊断设备、老年专业知识和临床培训对于减少 NH 中与跌倒相关的潜在可避免转移至关重要。实施和支持高级实践护士或扩展角色的护士为 NH 主管、政策制定者和医疗机构提供了重新设计资源的可能性，以限制不必要的转移，这对居民的护理质量有害，并对卫生系统造成代价高昂。
