The purpose of this study was to describe nursing home resident symptomatology and medical diagnoses associated with nursing home to hospital transfers. A retrospective chart review of documented transfers was conducted at a 120-bed, nonprofit urban Continuing Care Retirement Center nursing home facility located in the southwestern United States. The transferred residents ( ) had seventy different medical diagnoses prior to hospital transfer with hypertension, coronary artery disease, and congestive heart failure most frequently reported. Most frequently reported symptomatology included fatigue, lethargy or weakness, shortness of breath, and change in level of consciousness. Multiple symptomatology was indicative of a wide variety of medical diagnoses. The diagnoses and symptomatology recorded in this paper identify the importance of strategic planning concerning assessment and communication of common nursing home resident symptomatology and the importance of basic nursing and diagnostic procedures for prevention of potentially avoidable hospitalizations. 1. Introduction Potentially avoidable nursing home hospitalizations have become a focus for the United Stated Medicare and Medicaid System because of burgeoning costs totaling billions of dollars annually. One-third of nursing home residents are hospitalized each year. It is imperative to reduce avoidable hospital transfers to not only decrease cost to the health-care system but to also prevent the physical, psychological, and iatrogenic events that frequently manifest with hospital transfer [1]. Nursing home staff must be knowledgeable about the disease processes associated with advanced age, multiple comorbidities, and functional impairment to effectively and efficiently identify relevant symptomatology and communicate resident changes to avoid unnecessary hospitalizations [2]. Current nursing home staffing standards impact the process for reduction in unnecessary hospitalizations. Nursing home facilities are required to minimally provide licensed charge nurses (Licensed Vocational Nurses/LVN or Registered Nurses/RN) on each work shift [3]. The charge nurse managing the care of multiple patients is frequently an LVN, with activities of daily living provided by a Certified Nursing Assistant (CNA). An LVN has one year of education concerning basic nursing essentials and is responsible for providing safe nursing for individuals with predictable healthcare needs. The CNA has a minimum of 75 clock hours of training and is responsible for providing basic personal care to residents. The CNA reports resident
References
[1]
J. G. Ouslander, G. Lamb, R. Tappen et al., “Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project,” Journal of the American Geriatrics Society, vol. 59, no. 4, pp. 745–753, 2011.
[2]
J. L. Wolff, B. Starfield, and G. Anderson, “Prevalence, expenditures, and complications of multiple chronic conditions in the elderly,” Archives of Internal Medicine, vol. 162, no. 20, pp. 2269–2276, 2002.
[3]
N. G. Castle, “Nursing home caregiver staffing levels and quality of care: a literature review,” Journal of Applied Gerontology, vol. 27, no. 4, pp. 375–405, 2008.
[4]
S. D. Horn, P. Buerhaus, N. Bergstrom, and R. J. Smout, “RN staffing time and outcomes of long-stay nursing home residents,” American Journal of Nursing, vol. 105, no. 11, pp. 58–71, 2005.
[5]
D. C. Grabowski, K. A. Stewart, S. M. Broderick, and L. A. Coots, “Predictors of nursing home hospitalization—a review of the literature,” Medical Care Research and Review, vol. 65, no. 1, pp. 3–39, 2008.
[6]
J. G. Ouslander, G. Lamb, M. Perloe et al., “Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs,” Journal of the American Geriatrics Society, vol. 58, no. 4, pp. 627–635, 2010.
[7]
J. D. Walker, G. F. Teare, D. B. Hogan, S. Lewis, and C. J. Maxwell, “Identifying potentially avoidable hospital admissions from Canadian long-term care facilities,” Medical Care, vol. 47, no. 2, pp. 250–254, 2009.
[8]
H. Muenchberger and E. Kendall, “Predictors of preventable hospitalization in chronic disease: priorities for change,” Journal of Public Health Policy, vol. 31, no. 2, pp. 150–163, 2010.
[9]
M. P. Freiman and C. M. Murtaugh, “The determinants of the hospitalization of nursing home residents,” Journal of Health Economics, vol. 12, no. 3, pp. 349–359, 1993.
[10]
T. R. Fried and V. Mor, “Frailty and hospitalization of long-term stay nursing home residents,” Journal of the American Geriatrics Society, vol. 45, no. 3, pp. 265–269, 1997.
[11]
P. Gillen, D. Spore, V. Mor, and W. Freiberger, “Functional and residential status transitions among nursing home residents,” Journals of Gerontology A, vol. 51, no. 1, pp. M29–M36, 1996.
[12]
R. T. Konetzka, W. Spector, and T. Shaffer, “Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia,” Medical Care, vol. 42, no. 10, pp. 1001–1008, 2004.
[13]
M. W. Carter, “Factors associated with ambulatory care-sensitive hospitalizations among nursing home residents,” Journal of Aging and Health, vol. 15, no. 2, pp. 295–331, 2003.
[14]
M. W. Carter and F. W. Porell, “Nursing home performance on select publicly reported quality indicators and resident risk of hospitalization: grappling with policy implications,” Journal of Aging and Social Policy, vol. 18, no. 1, pp. 17–39, 2006.
[15]
O. Intrator, N. G. Castle, and V. Mor, “Facility characteristics associated with hospitalization of nursing home residents: results of a national study,” Medical Care, vol. 37, no. 3, pp. 228–237, 1999.
[16]
V. Mor, G. Papandonatos, and S. C. Miller, “End-of-life hospitalization for African American and non-latino white nursing home residents: variation by race and a facility's racial composition,” Journal of Palliative Medicine, vol. 8, no. 1, pp. 58–68, 2005.
[17]
D. D. Tresch, W. M. Simpson, and J. R. Burton, “Relationship of long-term and acute-care facilities. The problem of patient transfer and continuity of care,” Journal of the American Geriatrics Society, vol. 33, no. 12, pp. 819–826, 1985.
[18]
M. M. Bottrell, J. F. O'Sullivan, M. A. Robbins, E. L. Mitty, and M. D. Mezey, “Transferring dying nursing home residents to the hospital: DON perspectives on the nurse's role in transfer decisions,” Geriatric Nursing, vol. 22, no. 6, pp. 313–317, 2001.
[19]
J. L. Buchanan, R. L. Murkofsky, A. J. O'Malley et al., “Nursing home capabilities and decisions to hospitalize: a survey of medical directors and directors of nursing,” Journal of the American Geriatrics Society, vol. 54, no. 3, pp. 458–465, 2006.
[20]
Y. Young, N. R. Barhydt, S. Broderick, A. D. Colello, and E. L. Hannan, “Factors associated with potentially preventable hospitalization in nursing home residents in New York state: a survey of directors of nursing,” Journal of the American Geriatrics Society, vol. 58, no. 5, pp. 901–907, 2010.
[21]
D. C. Grabowski, A. J. O'Malley, and N. R. Barhydt, “The costs and potential savings associated with nursing home hospitalizations,” Health Affairs, vol. 26, no. 6, pp. 1753–1761, 2007.
[22]
O. Intrator, J. Zinn, and V. Mor, “Nursing home characteristics and potentially preventable hospitalizations of long-stay residents,” Journal of the American Geriatrics Society, vol. 52, no. 10, pp. 1730–1736, 2004.
[23]
L. Byrd, “Reducing avoidable hospitalizations in nursing could save $1 billion annually—so why delay?” Geriatric Nursing, vol. 30, no. 5, pp. 365–369, 2009.
[24]
E. Hutt, M. Ecord, T. B. Eilertsen, E. Frederickson, and A. M. Kramer, “Precipitants of emergency room visits and acute hospitalization in short-stay medicare nursing home residents,” Journal of the American Geriatrics Society, vol. 50, no. 2, pp. 223–229, 2002.
[25]
E. M. McMahan, K. Hoffman, and G. W. McGee, “Physician-nurse relationships in clinical settings: a review and critique of the literature, 1966–1992,” Medical Care Review, vol. 51, no. 1, pp. 83–112, 1994.
[26]
F. P. Robinson, G. Gorman, L. W. Slimmer, and R. Yudkowsky, “Perceptions of effective and ineffective nurse-physician communication in hospitals,” Nursing Forum, vol. 45, no. 3, pp. 206–216, 2010.
