Researchers at the State University of New York at Albany (SUNY) discovered that medical directors (MDs) and directors of nursing (DONs) have divergent views regarding preventing hospitalizations of nursing home residents. Preventing hospitalizations have both financial and health implications. One study concluded that nearly one-fourth of money spent on nursing home-related admissions were preventable.
Estimates vary on how many nursing home residents are hospitalized each year, from 9% to 59%. Identification and management of risk factors associated with hospitalizations have been shown to have a beneficial financial impact on the nursing home and enhances the quality of life for the resident. But MDs and DONs conflict in their opinions about what causes unnecessary hospitalizations among nursing home residents. Medical directors believe that access to medical records, medical director accessibility, physician pay, and staff knowledge of family preferences regarding care impact hospitalization. DONs do not believe that these aspects had an impact. They believe the inability to access lab results contributed to hospitalizations.
The medical directors’ accessibility, especially on weekends, is thought to reduce unnecessary hospitalizations. Specifically, their physical presence on site and on the care floor reduce uncertainty by aiding in medical decision-making during a health event. Similarly, having ready access to a comprehensive medical history helps frontline staff determine the extent of a crisis. Add this to the ability to access laboratory results and x-ray services and the accuracy of diagnoses increases exponentially. Finally, when staff members understand the family and resident preferences with regard to health care emergencies, the decision-making regarding hospitalization is much clearer. Studies have shown that physicians are more likely to hospitalize patients out of indecision and fear when they face family pressures or when the family’s wishes are unknown. The nursing staff needs to be aware of such preferences regarding hospitalization and maintain clear lines of communication regarding the clinical indications related to a hospital transfer.
The researchers conclude that unnecessary hospitalizations can be avoided if staff members work to improve communication between all levels of care (MDs, DONS, frontline staff, and family members) and enhance continuity of care between the nursing home and other health care providers.
Source: Young, Y., Inamdar, S., Barhydt, N., Colello, A., Hannah, E. 2009. Preventable hospitalization among nursing home residents: Varying views between Medical Directors and Directors of Nursing regarding determinants. Journal of Aging and Health. XX(X):ONLINEFIRST, 1-14.
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