PDF(Pubmed)
Abstract：
BACKGROUND: Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios.
METHODS: A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics.
RESULTS: Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions.
CONCLUSIONS: Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.
METHODS: A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics.
RESULTS: Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions.
CONCLUSIONS: Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.
摘要：
背景：将居民从疗养院（NHs）转移到急诊护理机构（ECF）经常受到质疑，因为许多人患有绝症并且可以获得现场护理。虽然一些NH到ECF的转会是有价值的，避免其他转移可能会使居民受益，并减少医疗保健系统成本和提供者负担。尽管在这方面进行了多年的研究，区分担保(即，适当)从不必要的NH到ECF的转移仍然具有挑战性。在这篇文章中,我们报告了关于有正当理由和没有正当理由的NH到ECF转移方案的共识。
方法：使用Delphi研究来确定有关必要和不必要的NH到ECF转移的共识。德尔福参与者包括来自NHs的护士(RN)和医生(MD)，非工作时间初级保健诊所(OOHs)，和医院急诊科。从有关导致转移的原因和医疗条件的现有文献中生成了12种情况和11种医疗条件的列表，并在进行研究之前对飞行员进行了测试和完善。进行了三次德尔福回合，数据采用描述性和比较性统计分析。
结果：七十九名专家同意参加，其中56人(71%)完成了所有三轮德尔福。与会者就何时不转移居民达成了很高或很高的共识，除了关于谵妄的场景，在那里只达成了适度的共识。相反，除非需要手术缓解疼痛，与会者就描述有必要的NH到ECF转移的方案达成了较低的共识。卫生专业人员之间的共识意见差异很大，参与者性别，和乡村，23种转移方案和医疗条件中的7种。
结论：从疗养院转移到紧急护理设施可以被定义为有保证，自由裁量,和毫无根据的。这些类别基于本Delphi研究中的共识领域，旨在将疗养院和紧急护理机构之间的合理和不必要的转移条款付诸实施。
方法：使用Delphi研究来确定有关必要和不必要的NH到ECF转移的共识。德尔福参与者包括来自NHs的护士(RN)和医生(MD)，非工作时间初级保健诊所(OOHs)，和医院急诊科。从有关导致转移的原因和医疗条件的现有文献中生成了12种情况和11种医疗条件的列表，并在进行研究之前对飞行员进行了测试和完善。进行了三次德尔福回合，数据采用描述性和比较性统计分析。
结果：七十九名专家同意参加，其中56人(71%)完成了所有三轮德尔福。与会者就何时不转移居民达成了很高或很高的共识，除了关于谵妄的场景，在那里只达成了适度的共识。相反，除非需要手术缓解疼痛，与会者就描述有必要的NH到ECF转移的方案达成了较低的共识。卫生专业人员之间的共识意见差异很大，参与者性别，和乡村，23种转移方案和医疗条件中的7种。
结论：从疗养院转移到紧急护理设施可以被定义为有保证，自由裁量,和毫无根据的。这些类别基于本Delphi研究中的共识领域，旨在将疗养院和紧急护理机构之间的合理和不必要的转移条款付诸实施。
