The Systemic Lottery - A Field Observational Study on the Detection and Management of Acute Events in Care Homes.
Trine Lenskjold Rudebeck, Dorthe Nielsen, Annmarie Touborg Lassen and 2 others
PMID 42698201WHAT IT FOUND
In Danish care homes, falls and sudden deterioration were most often noticed by care staff, but response depended on who was working, familiarity with the resident, and GP or nurse support.
Care varied by shift.
Key findings
01In four care homes, 38 acute events among 30 residents had falls as the most common indication, most events were detected during day shifts, residents stayed in the care home in more than half of cases, and four residents died within 7 days.
02Care staff were first to detect events, but detection depended on familiarity with the resident, competence varied, fall guidelines were not followed systematically, and staffing was lowest at night.
03Nurses, GPs, and advance treatment preferences shaped escalation and hospital admission, but advance decisions were rare and usually discussed after an acute event.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study took place in one Danish municipality with strong support structures, so it may not apply to care homes with less access to acute nurses, GPs, or emergency outreach. The observer's presence may have changed behaviour because staff knew they were being watched. The findings are qualitative and based on observation and informal interviews, so they cannot show that any specific process improves safety or reduces hospital use. Some events were known only through participants' accounts, and intimate care situations were not observed. The study did not measure outcomes for all residents, and the included sample was small and context-specific.
Declared interests
The Novo Nordisk Foundation funded the work. The authors declared no conflicts of interest.
The easy way to misread this
Do not read the variation in response as proof that a specific protocol or nurse-led process will reduce hospital admissions. The study observed what happened in care homes and did not test an intervention or measure outcomes.