Unpacking Fall-Related Transfers From The Nursing Home
31 Aug Unpacking Fall-Related Transfers From The Nursing Home
Because of muscle weakness, gait problems, and other factors, nursing home residents are at high risk for falls. Falls are a common reason for transfer to the hospital, but many of these transfers might be avoidable.
A recent study led by researchers at the University of Basel in Switzerland reviewed 81 fall-related transfers of nursing home residents from 11 facilities. Researchers worked with clinical experts to determine potential avoidability and nursing home stakeholders to discuss potential resources that could be implemented to reduce fall-related transfers. They found that 25% of fall-related transfers were potentially avoidable, and that 2/3 of these avoidable transfers were Emergency Department (ED) visits only without hospitalization. This builds on work led by Indiana University in the OPTIMISTIC study where fall-related transfers were more likely to be an ED evaluation only vs. a hospitalization compared to transfers for other reasons.
Most of the time when a resident is transferred to the hospital after a fall, it is necessary for treatment. There are opportunities, however, to assess and treat in place for some residents. This requires resources for timely evaluation and close monitoring. In the Swiss study, they cited that many transferred residents could have been seen in outpatient clinics.n. In the United States, we have more doctors and nurses on-site at nursing homes who can evaluate residents.. In addition, nursing homes may have access to local orthopedic “walk-in” clinics where a stable resident could be evaluated, bypassing ED’s entirely.
Unplanned transfers to the hospital are burdensome and disruptive to residents, their families, and the staff who care for them. Fall reduction is a common focus of QI initiatives. Yet, some falls will still occur given the many underlying risk factors of residents. Standardized, careful evaluation by nursing staff and access to timely resources including clinicians and mobile x-rays has the potential to reduce hospital transfers.
Key takeaways
¼ of fall related transfers from the nursing home are potentially avoidable
Access to on-site or outpatient clinical assessment can reduce these transfers
QI initiatives focused on fall reduction should also assess resources needed for reducing transfers
References
Guerbaai RA, Kressig RW, Zeller A, et al. Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers. JAMDA 2022;23(8):1304-1310.
Unroe KT, Caterino JM, Stump TE, et al. Long-stay nursing facility resident transfers: who gets admitted to the hospital? J Am Geriatr Soc 2020;68:2082-2089.
