Identifying the core components of a nursing home hospital avoidance programme.
Barbara J O'Neill, Trudy Dwyer, Lynne Parkinson and 2 others
PMID 35943901WHAT IT FOUND
A nursing home hospital avoidance programme relied on mandatory upfront training, clear subacute care definitions and family engagement.
Staggered 'on the job' training and missing policies led to staff confusion and inconsistent data recording. Core components were refined to include facility policy and executive support.
Key findings
01Staggered 'on the job' training was less effective than mandatory upfront training in helping staff recognise clinical deterioration, leading to confusion about what constituted subacute care.
02Family and care recipient education was added as a core component because families can insist on hospital transfers, and their confidence in the nursing home's capacity is essential for the programme to work.
03Supportive executive management and documented facility policies were identified as necessary core components to underpin the clinical changes required for the programme.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study relied on internal evaluators who were part of the implementation team, which may introduce bias in how the successes and failures of the programme were interpreted. Residents and their families were aware of the programme but were not included in the planning or implementation process, limiting insights into their direct experiences. The evaluation was complex due to the simultaneous assessment of the implementation process itself and the programme components, making it difficult to isolate the impact of specific changes.
Declared interests
The authors declared no conflicts of interest. The work was funded by a grant from the Australian Centre for Health Services Innovation, with support from PresCare, the not-for-profit aged care provider that owns the study sites.
The easy way to misread this
Do not conclude that the programme was proven effective by this study. This paper describes the implementation process and identifies core components for future programmes; it does not report patient outcomes like mortality or readmission rates for Site Two in this specific analysis.