Lead author Kathleen Unroe, MD, MHA, interim director of the Regenstrief Institute and IU Center for Aging Research and affiliated with the Indiana University School of Medicine, Division of General Internal Medicine and Geriatrics ( both in Indianapolis, IN) and colleagues report their findings after conducting a prospective clinical demonstration project that examined the recorded diagnoses of over 1,900 nursing home patients from 19 different nursing homes who were transferred to the hospital between November 2014 and July 2016. Dr. Unroe, who led the study, codirected Phase I of OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care) and is currently directing Phase II of OPTIMISTIC.
OPTIMISTIC-trained nurses found that 25% of patient transfers to acute-care hospitals included one of the following diagnoses: chronic obstructive pulmonary disease/asthma, cellulitis, pneumonia, dehydration, heart failure, pressure ulcer, or urinary tract infection. Because these conditions were considered manageable with appropriate resources within the nursing home, the transfers were considered potentially avoidable hospitalizations.
The authors note that their research demonstrates that the use of clinical diagnosis alone as an admission criterion may not be as important as ensuring that coordinated systems are in place to prevent potential harm to patients who are unnecessarily transferred to the hospital. Some of the recommended system enhancements included improving communication with the team and with the patient, who may express preferences for care; promoting earlier detection of a change in clinical status, condition, and symptoms; and alerting the team to seek palliative-care services at the earliest sign of possible need.
In a recent press release, Dr. Unroe described the importance of this study: “A long-stay nursing home resident shouldn't be sent to the hospital just because of miscommunication between doctors and nursing facility staff—we can do better than that.” Added Dr. Unroe, “Keeping complex patients in the nursing facility is often the right choice. A nursing facility setting—a familiar place with staff and clinicians who know the patient—may be the patient’s best option in many circumstances. We need to address this issue and improve care. Our findings highlight quality improvement opportunities and strongly reflect the need for multitargeted solutions like OPTIMISTIC.”
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