Nursing home administrators seeking the figurative canary in the coal mine to predict avoidable hospitalizations of residents might be looking in the wrong place.
Investigators with the Regenstrief Institute and the Indiana University Center for Aging Research made that assertion in study results released Tuesday. Typically, providers have viewed clinical diagnosis of a resident to determine whether a hospitalization can be avoided. But a much better indicator is whether the nursing home has coordinated systems in place, noted Kathleen Unroe, M.D., a Regenstrief Institute investigator and lead author of the study.
“From the nursing home’s perspective, it should be less about specific disease states, and more about putting in place excellent communication protocols, appropriate clinical staffing, access to diagnostic testing, and robust palliative care programs. Those are the answer to help all residents who have a change in status. Don’t over-focus on a specific condition or disease state,” Unroe told McKnight’s.
Nurses were embedded in 19 homes, and reviewed details on hundreds of transfers to the hospital. They pinpointed if residents had one of the six diagnoses most commonly linked with avoidable hospitalizations — pneumonia, urinary tract infections, dehydration, pressure ulcers, cellulitis, heart failure and chronic obstructive pulmonary disease/asthma.
About 25% of acute transfers of patients had a diagnosis in one of those six categories, while 22% did not. Meanwhile, the most common trait (45%) found amongst transfers was that the condition could have been managed safely if appropriate resources were available. Problems with communication between stakeholders were the most commonly noted area for improvement at about 48% of the time.
“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,” Unroe added in a press release. “Keeping complex patients in the nursing facility is often the right choice.”