"They Don't Trust Us": The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth.
Caroline E Stephens, Elizabeth Halifax, Daniel David and 4 others
PMID 31007055WHAT IT FOUND
Families and nursing home staff described transfers to the emergency department as often driven by distrust of nursing home assessments and physician availability.
After seeing telehealth, they thought video visits might reassure families, support nurses, and help goals-of-care talks.
Key findings
01Participants described a lack of trust in nursing home care as a common driver of emergency department transfers, linked to doubts about nurse assessments, absent physicians, unclear facility roles, and slow responses to medical needs.
02Nurses reported that their clinical assessments were sometimes disregarded or overruled by physicians, leading to transfers they regarded as unnecessary.
03Participants repeatedly valued remote visual connection as a possible way to let off-site physicians assess residents, validate nursing assessments, reassure families, and support goals-of-care conversations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was small and qualitative, so it reports stakeholder perceptions rather than measured transfer outcomes. Participants came from three counties in northern California and included families and providers but not nursing home residents themselves. Participants self-selected into a study about technology, so their positive views of telehealth may not represent people who are less interested in technology. The telehealth component was a video demonstration and discussion, not a real-world intervention with follow-up outcomes.
Declared interests
The authors declared no potential conflicts of interest. The article metadata lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that telehealth reduces emergency department transfers or improves nursing home resident outcomes. This was a qualitative study of stakeholder perceptions after a video demonstration; it did not test telehealth in practice or measure transfer rates.