Cummings Greta G, Tate Kaitlyn, Spiers Jude, El-Bialy Rowan, McLane Patrick, Park Claire Su-Yeon, Penconek Tatiana, Cummings Garnet, Robinson Carole A, Reid Robert Colin, Estabrooks Carole A, Rowe Brian H, Anderson Carol
Faculty of Nursing, College of Health Sciences University of Alberta Edmonton Alberta Canada.
Schulich School of Business York University Toronto Ontario Canada.
Health Sci Rep. 2024 Jul 4;7(7):e2204. doi: 10.1002/hsr2.2204. eCollection 2024 Jul.
BACKGROUND/OBJECTIVES: Transitions to and from Emergency Departments (EDs) can be detrimental to long-term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC-ED transitions and to verify the level of stakeholder agreement with this definition.
The amining ged are ransitions study adopted an exploratory sequential mixed-method design. The study was conducted in 2015-2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews ( = 25) and focus groups ( = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings.
Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups.
To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.
背景/目的：往返于急诊科（ED）可能对长期护理（LTC）机构的居民有害，并给医疗系统带来负担。虽然减少可避免的转诊势在必行，但各种术语却被交替使用，包括不适当、可预防或不必要的转诊。我们的研究目的是制定可避免的长期护理机构与急诊科之间转诊的概念定义，并验证利益相关者对该定义的认同程度。
本研究采用探索性序贯混合方法设计。2015年至2016年，在加拿大西部一个主要城市中心的16个长期护理机构、1个急诊科和1个紧急医疗服务（EMS）机构开展了此项研究。第一阶段包括80名参与者（医疗护理员、执业护士、注册护士、长期护理机构管理人员、居民家属和紧急医疗服务人员）。我们进行了半结构化访谈（25次）和焦点小组讨论（19次）。在第二阶段，327名急诊科工作人员、紧急医疗服务人员、长期护理机构工作人员和医疗主任根据定性研究结果对一项调查做出了回应。
可避免的转诊归因于长期护理机构资源有限、预防保健不足以及居民或家属的意愿。生成的定义为：如果满足以下条件，则长期护理机构居民转诊至急诊科被视为可避免的：（a）可以通过其他方式及时获得诊断检测、医疗评估和治疗；（b）转诊原因不明，且该转诊会增加居民的定向障碍、疼痛或不适，超过了转诊带来的明显益处；（c）该转诊违背了居民长期表达的意愿，包括通过非正式和无记录的交谈所表达的意愿。四个参与组对该定义的认同程度很高。
为有效减少长期护理机构居民的可避免转诊，利益相关者必须共享一个共同的定义。我们的概念定义可能会对改善长期护理机构居民的护理做出重大贡献。
