Challenges in transitional care between nursing homes and emergency departments

Objective: To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents. Design: Structured focus group interviews. Participants: Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians. Setting: Two NHs, 2 EDs, and a county-wide EMS system. Analysis: Audiotaped discussions were transcribed and analyzed independently by 2 authors. Results: Themes included barriers to providing high-quality care, data needed when residents are transported in both directions between EDs and NHs, and possible solutions to improve care. Communication problems were the most frequently cited barrier to providing care. Residents are often transported in both directions without any written documentation; however, even when communication does occur, it is often not in a mode that is useable by the receiving provider. ED personnel need a small amount of organized, written information. When residents are released from the ED, NH personnel need a verbal report from ED nurses as well as written documentation. All groups were optimistic that communication can be improved. Ideas included use of (1) fax machines or audiotape cassette recorders to exchange information, (2) an emergency form in residents' charts that contains predocumented information with an area to write in the reason for transfer, and (3) brief NH-to-ED and ED-to-NH transfer forms that are accepted and used by local NHs and EDs. Conclusion: The transitional care of NH residents is laden with problems but has solutions that deserve additional development and investigation.