A systematic review on the experiences of Residential Aged Care Facility staff decision making regarding the transfer of residents to Emergency Departments.

Abstract

Review question/objective The objective of this review is to synthesise the best available evidence on experiences of RACF staff decision making regarding the transfer of residents to the Emergency Department. Specifically, the review question is: what are the experiences of RACF staff who have been involved the decision to transfer residents to an emergency department? Inclusion criteria Types of participants This review will consider international publications that focus on RACF staff involved in decisions regarding the transfer of residents from the RACF to the ED. All RACF nursing and care staff will be considered including, Registered Nurses RN, Enrolled Nurses EN, Personal Care Attendants PCA and Licensed Practice Nurses LPN. However, due to the ambiguity in nomenclature, no terms for RACF staff will be used in the search criteria and instead the reviewers will identify whether the sample focuses on RACF staff in the sifting phase. Phenomena of interest The phenomena of interest for this review are the experiences of RACF staff decision making regarding the transfer of residents to the Emergency Department including the experiences of the facilitators and barriers to providing care for residents within the RACF when a resident’s health deteriorates. These experiences may refer to the following issues described already in the existing literature: limited access to medical review, the influence of family and resident preferences, the requirement to follow facility transfer protocols, fear of litigation, difficulties identifying the cause of the resident’s deterioration, communication difficulties and the influence of a skill mix. Context The context for this systematic review is the RACF, which are defined as facilities that provide both permanent accommodation and the provision of personal care and nursing services. 3 Studies referring to nursing homes, long-term care settings and skilled nursing facilities will be included. Studies that are undertaken in the community or the acute care setting will be excluded because the focus in on decision-making within the RACF setting. Studies using other descriptions of RACF such as low care facilities, assisted living facilities, homes for the elderly will be critiqued to establish whether they met our definition for inclusion.