Mobile x-ray services; outcome for nursing home residents and society - a literature review

Abstract

Introduction: Nursing home residents who are in need of radiological services usually transfers to hospital, even for x-ray examinations like chest or skeletal x-ray possible to provide with a digital mobile x-ray unit at site. Nursing home residents, and especially residents with dementia, needs familiar surroundings to feel safe. New surroundings like the x-ray department in a hospital may lead to increased anxiety or disorientation. To achieve person-centred processes in healthcare services the organization needs to facilitate person-centred care. The objective of this study is to summarize the benefits nursing home residents and the society in general gets for mobile x-ray services. Methods: A systematic literature search was performed in PubMed, Cinahl, AgeLine, EBSCOhost and SveMed+ databases in October 2015. Studies were eligible when reporting on mobile x-ray units serving nursing homes. The following search terms were used: Mobile radiography, Cost effectiveness, Nursing home, Portable radiography, Mobile health units and different combinations of these search phrases. A Google search gave access to a cost-effectiveness report from Norway. Articles in English, German and Norwegian were included. The author selected studies, assessed studies, and extracted data in the review. Results: Ten articles and one cost-effectiveness analysis were included in the review. The review shows mobile x-ray units set up in Australia, Italy, Switzerland, Sweden and Norway. Six studies shows mobile x-ray units to reduce the burden of transportation to hospital for chest, skeletal and abdominal x-ray examinations. Five studies reports reduction in hospitalizations or visits to the emergency room. Reduction in resourced used when staff accompany residents to hospital were found in six studies. One study and one cost-effectiveness analysis shows cost-effectiveness of mobile x-ray services in Norway, one study shows cost-effectiveness in Sweden. Discussion: Transfer of residents to hospital for simple x-ray examinations lead to a significant and partly unethical burden for nursing home residents, and especially those with dementia. Examinations performed locally in nursing homes reduced unnecessary anxiety and confusion, especially for residents with dementia. One study found 17% of the residents in their study examined at hospital developed delirium requiring treatment, were as none of the residents examined at home developed delirium. Included studies show mobile radiography services to decrease the need for hospitalization and transportation of nursing home residents. More patients receive treatment at the nursing home with reduction of medical complications after hospital treatment. Being in the nursing home the care environment are more suited for nursing home residents compared to the x-ray department or a hospital ward. Mobile x-ray services therefore can contribute to person-centred care processes in nursing homes. Mobile x-ray units might pose a need for knowledge in nursing homes on preparation for and carrying out x-ray procedures. Nursing homes might also needs increased knowledge in treatments usually given in hospitals. In addition to benefits for residents, there are potential socio-economic benefits from mobile x-ray services. Calculations showed cost-effectiveness in Oslo and other urban areas of Norway even without including reduced costs from reduction in hospitalizations. Cost reduction estimated to 30-60% per x-ray examination depending on the number of examinations per nursing home visit and the distance between nursing home and hospital. The costs of the service and the savings are not within the same budget. This poses challenges for decision-makers to be able to see an increased cost in their department to be part of an overall cost reduction for society. Conclusion: Mobile x-ray services provides a way to organize the radiological service for nursing home residents highly beneficial for the residents. Reducing anxiety, confusing and delirium. The reduction in use of ambulance and taxi transportation with personnel accompanying the residents to hospital proves the mobile x-ray services to be cost-effective in urban areas of Norway and in Sweden. There is a limited number of studies on mobile x-ray services; Norway being the country with the largest contribution therefore dominates the results. There is a need for cost-effectiveness analysis for larger areas and more countries. There is a need for further research on the quality of mobile x-ray services and strategic leadership when establishing mobile services.