Lack of physicians at the nursing homes during off hours is one of the main causes of avoidable hospitalizations. When a medical issue comes up during evening or over the weekend that cannot be addressed over phone, the on-call physician has the option to either travel to the facility or recommend that the resident be transferred to a hospital. More often than not, the on-call physician will recommend the latter. This finding is a result of qualitative research done on the subject to determine the main factors leading to hospitalization of nursing home residents and whether or not those could be avoided. Let’s have a quick look at this research. Since these highlight one of the main causes for such hospitalizations to be the lack of a physician present in nursing homes during off hours e.g. weekends or after midnight during weekdays, we will also talk about how important the role of communication is in a medical setting.
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
A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 concludes that residents who did not get an opportunity to be seen by a physician were more likely to have a poor outcome like:
- Return to the hospital
- Failure to return successfully to the community
The study suggests that ensuring physicians see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations. For many years, lack of adequate nurse staffing levels has been linked with re-hospitalization of residents. Published thirty years ago, a three-year long study of non-clinical factors contributing to the re-hospitalization of residents finds that insufficient and inadequately trained nursing staff who could not help with residents’ complex health care needs caused the latter’s re-hospitalizations. (J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989))
Can Communication Help in Avoiding Hospitalization of Nursing Homes Residents?
A study that experimented with telemedicine found out that by making medical consultation available to nursing home patients and their families via two-way videoconferencing, hospitalizations can be avoided.
Hucu’s Patient-Centered Communication
Hucu is a free HIPAA compliant texting app that allows healthcare professionals to flag patients when changes in condition occur and to notify the relevant staff members immediately. The Hucu application allows medical teams to communicate with each other without the need to fill and submit forms. Its real-time communication allows critical information to be passed quickly to the front line staff. One of the key features of Hucu is reporting that helps with accountability.
Reporting is available for quality assurance team members, administrators and DONs to learn which staff member is communicating effectively and how that affects the patient’s chances of hospitalization. The transparency offered by Hucu.ai allows medical professionals to identify high performing staff members and needs for further training.
As indicated by the research, lack of communication with a physician in a timely manner can lead to hospitalizations that can be easily avoided in nursing homes. Hucu can empower the staff members to communicate with relevant healthcare professionals effectively from a remote position and as a result take better care of the patient round the clock.
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