Abstract
BackgroundVisits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.MethodsTwo cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.ResultsWe received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492).ConclusionsA substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.
Highlights
Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications
Most responding physicians worked in group practices or medical care centres (67.0%) and the bulk of respondents worked in rural areas (52.3%)
The physicians cared for 46.8 NH residents (SD: 43.5; range: 0–360) and they had been working as a general practitioner (GP) for 18.0 years (SD: 10.8; range 1–48)
Summary
Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications Many of these transfers are considered inappropriate. Due to increased frailty and vulnerability [5,6,7] residents are at higher risk for (acute) hospital transfers than the older communitydwelling population [8,9,10,11] These visits in emergency departments (EDs) with subsequent discharge to the NH (in the following named ED visits) and hospital admissions are even more common in Germany than in other Western countries [12, 13] with 0.5 ED visits and 1.2 hospital admissions per resident and year [14]. A comparably high proportion (30%) of German NH residents die in hospital [15, 16]
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