Emerg physicians complain that it is time-consuming to call nursing homes to gather information. Sitting on-hold for a few minutes in order to get an accurate history about a complex patient and a clear sense of patient and family expectations from a first-hand observer is probably more time- and resource-efficient than ordering a lot of unnecessary tests or interventions – or missing an important diagnosis.
Departures from nursing homes are usually arranged emergently about a perceived rapid change in condition by staff who are not familiar with medical emergencies. Keeping that in mind during your conversation may improve the quality of the conversation.
If you work in an ED setting that receives most nursing home transfers from one or two institutions, it can be efficient to arrange a meeting with the medical and nursing directors to address improved strategies.
In order to ensure high-quality ongoing care for the patient – and to avoid early ED return – it is essential to communicate back to the nursing home, on paper or electronically:
- the results of investigations (bloodwork, imaging)
- new diagnoses,
- changes of medications,
- a care plan.
Return of Patient to Nursing Home
Not surprisingly it is a perennial complaint from nursing home staff – MD and Nursing – that inadequate information is transferred back to them regarding the patient’s in-hospital care.
Ideally an attempt should be made to involve next-of-kin or powers of attorney if not present in this communication to ensure that all decision-makers are aware of the plan.
Some EDs have developed protocols for return-to-nursing home, including the requirement of a nurse-to-nurse phone call – like any in-hospital transfer. For an example of an Emergency Department Transfer Report for Long Term Care Patients, click here.