Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-2021]

Attitude of Health Personnel* ; Emergency Service, Hospital* ; General Practitioners* ; Hospitalization* ; Nurses* ; Nursing Homes* ; Patient Transfer*; Advance Directives ; Cross-Sectional Studies ; Female ; Germany ; Humans ; Male ; Middle Aged ; Nursing Staff ; Personnel Staffing and Scheduling ; Surveys and Questionnaires

Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.
Methods: Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.
Results: We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492).
Conclusions: A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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Keywords: Emergency department; General practitioner; Hospital transfer; Hospitalisation; Nursing home; Nursing home residents; Nursing staff; Survey

Date Created: 20200213 Date Completed: 20201130 Latest Revision: 20210110

20250114

PMC7014634

10.1186/s12875-020-01108-x

32046652