Strong ties with hospital staff could reduce nursing home ED referrals

Registered nurses who work in nursing homes need to rely on their colleagues in hospitals to determine whether it's necessary to refer nursing home residents to the emergency department (ED), according to a new study in the Open Journal of Nursing.

Researchers, led by Annica Kihlgren of the School of Health and Medical Sciences,, Örebro University, Örebro, Sweden, set out to determine how nurses in nursing homes make the decision to refer their elderly residents to the ED.  Kihlgren and her team analyzed interviews with 13 nurses who worked at 11 nursing homes in Sweden and discussed the factors behind their decision for every 10th hospital transfer that occurred during a one-year period.

They found that when nurses had a distant relationship with their colleagues at hospitals or a previous negative experience, they often felt insecure and alone in their decision-making. Hospital staff, they said, would sometimes question their competence. As a result, they sometimes hesitated to refer patients to the ER and typically turned to their colleagues in the nursing home for advice.

"We spend hours trying to contact the relevant physicians, and sometimes when you reach a nurse or physician at the hospital you feel they are questioning you and your competence," one nurse said in the study.

But nurses need to feel secure that nursing home staff could provide necessary care if they didn't transfer the patient to the ER, researchers noted. 

It's important that RNs in nursing homes receive education to strengthen their decision-making and avoid unnecessary referrals and hospitalizations, according to the authors. "Referrals due to the lack of resources are not only wasteful but can worsen the older persons' health," they concluded.

To learn more:
- here's the study abstract
- read the study (.pdf)