Transfers to the emergency department (ED) and hospital admissions/readmissions are sometimes necessary to provide the appropriate level of care needed to address a resident’s current health status. However, data shows that a percentage of ED visits and hospital admissions/readmissions are potentially preventable. In addition, these transitions can be highly disruptive for frail individuals.
Nursing facilities are currently reporting hospitalizations and ED visits for their residents. This information is publicly reported on Nursing Home Compare. Do you regularly look at the publicly reported data? Have you incorporated this data as part of your Quality Assurance and Performance Improvement (QAPI) program? Facilities should have a process for monitoring and reporting this information at their regular QAPI meetings. The current facility rates should be compared to the state and national averages (which are also reported on Nursing Home Compare). The resource Quality Improvement Review of Transfers; Drivers of Admissions and Readmissions can help your team explore the drivers of potentially preventable ED visits and hospital admissions/readmissions and identify performance improvement opportunities.
Once you have incorporated evaluating potentially preventable ED visits and hospital admissions/readmissions into your QAPI program and you have implemented any necessary performance improvement projects (PIPs) can you sit back and rest on your success? Maybe. But have you ever considered involving your residents and family members in your efforts to reduce potentially preventable ED visits and hospital admissions/readmissions?
Consider having conversations with residents and family members. The Go to the Hospital or Stay Here Decision Guide was developed to help residents and family members make an informed decision about going to the hospital if a change in condition occurs. This resource outlines reasons the resident may prefer treatment in the nursing facility and the hospital, risks to hospitalization and how they can be involved in the decision. Share this information with the residents prior to a situation where they are ill or in the middle of a crisis so they are better prepared to make an informed decision should the need arise.
If a resident is readmitted to the hospital, you may want to consider using the Resident/Family Interview Form to help identify what could have been done differently that might have prevented the hospitalization. This feedback can be used in the implementation of a PIP or the refinement of an already existing PIP.
There is an increased risk of infection and adverse drug reactions for residents who are sent to the ED or hospital. Monitoring unnecessary ED visits and hospitalizations and implementing processes to reduce these will help keep our residents safe.