Emergency calls from care homes are often made too quickly. Let's look at what really helps your residents.
Emergency calls from care homes are often made too quickly. Let's look at what really helps your residents.
Did you know that many emergency ambulance trips from care homes could actually be avoided if medical help was available right on-site? Studies clearly show just how much of a positive difference in-person care can make for residents—even when it comes to the comforting choice of where they spend their final days.
Did you know that many emergency ambulance trips from care homes could actually be avoided if medical help was available right on-site? Studies clearly show just how much of a positive difference in-person care can make for residents—even when it comes to the comforting choice of where they spend their final days.
If a person in a care home suddenly deteriorates, calling emergency services is often the quickest path. Understandable, but not always the best. International evaluations show that some of these transfers to the emergency department could have been avoided if medical assistance had been available in-house. Read here what this means for residents, relatives, and care teams.
Why do care home residents end up in the emergency department so frequently?
A systematic review analysed 77 studies on transfers from care homes to emergency departments. Depending on the study and the definition used, between 4 and 55 per cent of these transfers were classified as inappropriate [1]. While the range is wide due to differing methodologies in each study, the trend is clear: a significant proportion of these journeys could be avoided.
The review identifies medical availability, both during and after regular working hours, as a central obstacle [1]. If no one is available to assess a situation on-site, the nursing staff are often left with no choice but to call emergency services. This is not due to overzealousness, but rather a sense of responsibility.
What difference does on-site medical care make?
The figures from the same systematic review are clear. A programme shifting medical care directly into the care home reduced emergency department presentations by 17 per cent and hospital admissions by 37 per cent [1]. Improved medical integration with continuous care reduced transfers overall by 34 per cent. The structured INTERACT programme lowered avoidable admissions by 15 per cent, without altering the overall number of hospital visits.
One finding goes beyond mere statistics: of those residents with the best-integrated primary care, 5 per cent died in hospital, compared to 14 to 27 per cent of those receiving standard care [1]. For many individuals, this represents the precise difference between spending their final hours in an unfamiliar environment and remaining in their accustomed room.
Why medication lists require regular review
Residents in care homes are frequently prescribed multiple medications. Structured medication reviews are therefore well-researched [2], and when residents and their relatives are involved in the decision-making process, specific medications can be successfully discontinued [3]. In the interest of accuracy, it must be noted that there is as yet no conclusive scientific evidence that this definitively improves hard endpoints such as falls or mortality. What does emerge, however, is an improved suitability of the therapy.
Why do care home residents end up in the emergency department so frequently?
A systematic review analysed 77 studies on transfers from care homes to emergency departments. Depending on the study and the definition used, between 4 and 55 per cent of these transfers were classified as inappropriate [1]. While the range is wide due to differing methodologies in each study, the trend is clear: a significant proportion of these journeys could be avoided.
The review identifies medical availability, both during and after regular working hours, as a central obstacle [1]. If no one is available to assess a situation on-site, the nursing staff are often left with no choice but to call emergency services. This is not due to overzealousness, but rather a sense of responsibility.
What difference does on-site medical care make?
The figures from the same systematic review are clear. A programme shifting medical care directly into the care home reduced emergency department presentations by 17 per cent and hospital admissions by 37 per cent [1]. Improved medical integration with continuous care reduced transfers overall by 34 per cent. The structured INTERACT programme lowered avoidable admissions by 15 per cent, without altering the overall number of hospital visits.
One finding goes beyond mere statistics: of those residents with the best-integrated primary care, 5 per cent died in hospital, compared to 14 to 27 per cent of those receiving standard care [1]. For many individuals, this represents the precise difference between spending their final hours in an unfamiliar environment and remaining in their accustomed room.
Why medication lists require regular review
Residents in care homes are frequently prescribed multiple medications. Structured medication reviews are therefore well-researched [2], and when residents and their relatives are involved in the decision-making process, specific medications can be successfully discontinued [3]. In the interest of accuracy, it must be noted that there is as yet no conclusive scientific evidence that this definitively improves hard endpoints such as falls or mortality. What does emerge, however, is an improved suitability of the therapy.
“The most important question in a care home isn't how quickly the ambulance arrives, but whether someone was there for you before you even had to call them.”
“The most important question in a care home isn't how quickly the ambulance arrives, but whether someone was there for you before you even had to call them.”
“The most important question in a care home isn't how quickly the ambulance arrives, but whether someone was there for you before you even had to call them.”
What does this mean for your facility?
The common denominator of all effective models is simple: it requires designated attending physicians who know the facility and the residents, regular ward rounds instead of random consultations, and an accessible telephone number when acute situations arise. This is complemented by medication reviews, wound management, and clear coordination with the nursing team.
This is precisely how we, as a primary care centre, collaborate with several Viennese care homes. You can see which ones these are on our reference page. If you would like to discuss a care concept for your institution, please get in touch via the contact page.
When is admission to hospital still appropriate?
Whenever there is a genuine medical emergency. Suspected stroke or myocardial infarction, severe injury following a fall, acute dyspnoea, or loss of consciousness belong immediately in the rescue chain, emergency number 144. The goal is not to avoid transfers altogether, but rather the unnecessary ones.
What are the concrete benefits of a medication review?
It provides a clear overview. Preparations that potentiate each other or whose therapeutic benefit is no longer present are identified. Together with the resident and their relatives, a decision is made regarding what remains and what can be discontinued [3].
How does a collaboration begin?
With a discussion about your institution: size, care specialisms, previous medical coverage, and the issues that cause the most pressure in daily operations. This forms the basis of a care concept tailored to your facility.
References
Image credits: Photographs of our partner facilities St. Carolusheim and Park Residenz Döbling.
What does this mean for your facility?
The common denominator of all effective models is simple: it requires designated attending physicians who know the facility and the residents, regular ward rounds instead of random consultations, and an accessible telephone number when acute situations arise. This is complemented by medication reviews, wound management, and clear coordination with the nursing team.
This is precisely how we, as a primary care centre, collaborate with several Viennese care homes. You can see which ones these are on our reference page. If you would like to discuss a care concept for your institution, please get in touch via the contact page.
When is admission to hospital still appropriate?
Whenever there is a genuine medical emergency. Suspected stroke or myocardial infarction, severe injury following a fall, acute dyspnoea, or loss of consciousness belong immediately in the rescue chain, emergency number 144. The goal is not to avoid transfers altogether, but rather the unnecessary ones.
What are the concrete benefits of a medication review?
It provides a clear overview. Preparations that potentiate each other or whose therapeutic benefit is no longer present are identified. Together with the resident and their relatives, a decision is made regarding what remains and what can be discontinued [3].
How does a collaboration begin?
With a discussion about your institution: size, care specialisms, previous medical coverage, and the issues that cause the most pressure in daily operations. This forms the basis of a care concept tailored to your facility.
References
Image credits: Photographs of our partner facilities St. Carolusheim and Park Residenz Döbling.
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If you enjoyed this article, then you probably feel exactly the same way we do: the urge to take action and really make a difference. But why should you stop at just reading? Join us and become part of what we are building here.
