Kathleen Unroe, M.D., MHA

Care providers can take action to make hospital and emergency room transfers safer for nursing home residents during the coronavirus pandemic, according to a group of eldercare experts.

“Clear communication about treatment preferences and expectations has never been more important,” said Kathleen Unroe, M.D., a practicing geriatrician and researcher with the Indiana University Center for Aging Research at Regenstrief Institute. “Especially during this pandemic, clarity on resident and family goals for care is critical.”

Unroe and colleagues have published a comprehensive guideline on safe and effective transitions that includes the following checklist points (summarized):

  • Medically stable patients who are appropriately isolated should not be transferred to the emergency department. Multidisciplinary teamwork can support providing care in place.
  • Address advance care planning with every patient and family in the context of COVID-19.
  • Carefully weigh the risks and benefits of transferring residents with a febrile respiratory illness to an emergency department. This includes an evaluation of the patient’s current state of health, patient-centered goals, and an assessment of prognosis in the context of COVID-19 illness.
  • Consider “forward triage” when considering patients for care transitions. This involves assessing the resident’s level of acuity. This should involve a conversation with the receiving emergency department physician.
  • Warm hand-offs are critical. Nursing home and emergency department providers need to communicate prior to a transfer and as medical decisions are being made, including the ability of the nursing home to safely accept a returning resident.
  • Bi-directional communication should be made an essential practice.

Support teams help reduce resident hospitalizations by 30%

The multidisciplinary care advocated by Unroe’s team may accomplish more than easing resident transfers. When advanced practice registered nurses are supported by a team, the need for these disruptive moves may be significantly reduced, according to University of Missouri researchers.

Researchers followed 16 Midwest nursing homes participating in the Missouri Quality Initiative. In the program, skilled nurses were mentored by highly trained nurses, a social worker, a medical director and health information coordinator. Feedback reports were provided to team leaders.

While the facilities originally had higher hospitalization rates than the national average, the program has resulted in a 30% reduction in hospital admissions since 2012, reported investigator Amy Vogelsmeier, Ph.D., RN, and colleagues.