Objectives: Nursing home (NH) residents are a frail and vulnerable population often faced with iatrogenic effects of hospital stays when transferred to emergency departments for acute changes in health status. Avoidable or unnecessary transfers of care need to be identified and defined to prevent unintended harm. The aim of this scoping review was to identify characteristics of avoidable or unnecessary transitions of NH residents to emergency departments, and examine factors influencing decision-making by NH staff, residents, and their family members to transfer nursing home residents to emergency departments.
Methods: The search strategy began with 5 electronic databases, and a hand search of gray literature. Published qualitative and quantitative studies were included that examined the definition of avoidable or unnecessary transfers, and/or reported factors associated with decision-making to transfer NH residents to emergency departments. Methods included quality assessments, data extraction, and synthesis using content analysis.
Results: A total of 783 titles and abstracts were retrieved and screened resulting in 19 included studies. Results describing "avoidable" or "unnecessary" transfers were grouped into 3 dimensions of factors: management of early-acute or low-acuity symptoms and chronic disease management in NHs, ambulatory care-sensitive indicators, and use of post hoc assessments. Five categories of factors contributing to decision-making to transfer were identified: nursing factors, physician factors, facility/resource factors, NH resident/family factors, and health system factors. A consensus on the definition of "avoidable" or "unnecessary" transfers was not found.
Conclusion: Findings suggest that transfers of NH residents to emergency departments may be avoided with increased care capacity within NHs. The decision-making process involved in the transfer is influenced by many factors, with intentions of both improving clinical outcomes and maintaining quality of life for the NH resident. Acute changes in health status are contextually specific and decisions must consider not only the resident's acute condition, but also resources available in the NH, and resident and family members' preferences for care. A definition of "avoidable" or "unnecessary" transfer must include reliable measurement, yet remain flexible enough to be generalizable to various care facilities to meet the needs of NH residents and manage required care safely within the NH. Robust research aimed at improving the primary care of NH residents is essential to informing health policy reform and education of those providing care in NHs.
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http://dx.doi.org/10.1016/j.jamda.2016.05.012 | DOI Listing |
J Osteopath Med
January 2025
Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA.
Context: Point-of-care ultrasound (POCUS) has diverse applications across various clinical specialties, serving as an adjunct to clinical findings and as a tool for increasing the quality of patient care. Owing to its multifunctionality, a growing number of medical schools are increasingly incorporating POCUS training into their curriculum, some offering hands-on training during the first 2 years of didactics and others utilizing a longitudinal exposure model integrated into all 4 years of medical school education. Midwestern University Arizona College of Osteopathic Medicine (MWU-AZCOM) adopted a 4-year longitudinal approach to include POCUS education in 2017.
View Article and Find Full Text PDFWorld J Clin Cases
January 2025
Department of Dermatology, Cosmetology and Venereology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, Guangdong Province, China.
Background: Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.
Aim: To assess Burundi healthcare workers (HCWs)s' level of knowledge and confidence in the diagnosis and management of Mpox.
Methods: We conducted a cross-sectional study an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.
Background: Neighborhood physical disorder has been linked to adverse health outcomes, yet longitudinal assessments of its relationship with metabolic and inflammatory biomarkers in older adults remain limited. This study examined the association between patterns of neighborhood physical disorder exposure and biomarkers among older adults.
Methods: We included community-dwelling Medicare beneficiaries with 2017 biomarker data from the National Health and Aging Trends Study (n = 4,558).
JBI Evid Synth
January 2025
Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliated Group, MANT, Kolkata, India.
Objective: This review aims to estimate the prevalence and incidence of zoonotic diseases from studies of populations from South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka).
Introduction: South Asia is of notable importance in terms of the prevalence and incidence of endemic zoonoses, as well as its role as a focal point for emerging zoonotic diseases.
Inclusion Criteria: All populations residing in the 8 South Asian countries, irrespective of age/gender, will be considered.
Can J Psychiatry
January 2025
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Objective: To examine factors associated with high intensity physician-based mental health care services in a population-based sample of children and youth in Ontario, Canada.
Methods: Data from the 2014 Ontario Child Health Study (OCHS) were linked at the person-level to longitudinal health administrative databases containing physician contacts in outpatient settings, emergency departments and hospitals. Our analytical sample (15.
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