Research by Georgia Medical Care Foundation
A six-month prospective quality improvement initiative conducted by the Georgia Medical Care Foundation, the Medicare Quality Improvement Organization (QIO) for Georgia found that a substantial percentage of hospitalization can be avoided and the saved money can be re-invested to improve the quality of nursing homes in the US. In the project, three participating nursing homes were given communication and clinical practice strategies and tools to help reduce the potentially avoidable hospitalizations. These included:
- Use of an early warning tool (Stop and Watch) for communication between licensed nurses and nursing assistants.
- Introducing an SBAR (Situation, Background, Assessment, and Recommendation) tool using case studies on common reasons for avoidable hospitalizations.
- Establishing communication protocols for reporting change in condition from nursing home staff to primary care clinicians
- Facilitating interaction between the nursing home, emergency room and acute care hospital staff through site visits to understand role and abilities.
- Access to telephonic support by an advanced practice nurse.
The research found that although no facility fully implemented the communication tools and strategies, the partial implementation led to a staggering 50% reduction in the overall rate of hospitalizations during the six months study period. The research also concluded that while INTERACT (Interventions to Reduce Acute Care Transfers) tools were valuable in everyday practice; they cannot be used as frequently. The main barrier is the perception of additional paperwork which results in many of the forms not being used.
Research by AB Cohen: Avoiding Hospitalizations from Nursing Homes for Potentially Burdensome Care
Another qualitative study published in 2017 had sought to understand the reasons why some nursing homes are more successful than others at preventing avoidable hospitalizations. The study was conducted in Connecticut nursing homes with hospitalization rates in top or bottom 10%. It was found that:
“Facilities using publicly available data (http://www.ltcfocus.org) and conducted in-depth, semi structured interviews with key staff members, using a standard interview guide, until theoretical saturation was reached. Interviews occurred at 4 high-hospitalizing and 4 low-hospitalizing facilities and involved directors of nursing, facility administrators, physicians, advanced practice clinicians and other staff. Participants at all facilities recognized that residents were hospitalized for potentially burdensome care and identified a common set of barriers that made it difficult to avoid such transfers.”(Cohen AB, Knobf MT, Fried TR. Avoiding Hospitalizations From Nursing Homes for Potentially Burdensome Care: Results of a Qualitative Study. JAMA Intern Med. 2017.)
The set of barriers mentioned in the study included:
- Families’ guilt pushing them to do everything they can in an emergency situation includes hospitalization.
- Families’ belief that nursing home provides inferior care.
- Unavailability of clinicians at nights and weekends
- Difficult decisions faced by staff in relative isolation.
Research on Factors Contributing to the Hospitalization of Nursing Home Residents
- Return to the hospital
- Death
- Failure to return successfully to the community
Can Communication Help in Avoiding Hospitalization of Nursing Homes Residents?
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