A new analysis aims to better understand why frail skilled nursing facility residents are often transferred to emergency departments, despite the inherent dangers. A lack of trust in the capabilities of  skilled care facilities seems to be a driving factor.

Key study takeaways for nursing facility leaders are the need to better understand and manage patient expectations, and bolster hospital partnerships. Telehealth could be an important piece of the puzzle in improving these transitions, said lead author Caroline Stephens, Ph.D., with the University of California, San Francisco.

“There is an opportunity for greater collaboration between hospitals and nursing homes to better understand and set expectations for residents, families and healthcare providers about what NHs can and cannot provide, and when it might be appropriate to transfer to the ED,” said Stephens, who is associate director of the UCSF’s John A. Hartford Center of Gerontological Nursing Excellence. “It is important to help families understand more care does not necessarily translate to better care for their loved ones and we need to ensure that the care we are providing is congruent with what they want.”

Stephens and colleagues came to their conclusions by conducting eight focus groups with patients and caregivers. They found that transfers to the emergency department were often fueled by four factors: (1) doubts about the quality of skilled care facility nurses’ assessments; (2) perceptions that physicians were absent from the nursing home; (3) misunderstanding the relative capabilities of skilled care settings and emergency departments; and (4) beliefs that responses to medical needs were inadequate.

Authors found that telehealth technology could help improve the quality of assessments and communication, calm patient and family worries, and reduce unnecessary trips to the emergency department. Given the lack of palliative care specialists in nursing homes, the use of video visits to connect residents with such experts is a “promising opportunity,” Stephens told McKnight’s.

“Families not having adjusted to the idea that end of life was close at hand was found to be a precipitating factor leading to transfers to the ED. The feeling was that unhappy with their loved ones’ condition, they did not suspect serious illness or failing health, but rather assumed the system was failing them. This led us to conclude that improving access to palliative care in nursing homes was a key component in reducing unnecessary transfers,” Stephens said.

The study was published last month in Clinical Nursing Research.