Abstract
Background: Long-term care (LTC) residents are at high risk of being admitted to acute hospitals (Boyd et al., 2011). Reducing preventable hospitalisations are essential in order to promote quality of care, improve health conditions and reduce expenditure. Vulnerable elderly individuals receiving long-term care could significantly benefit from reducing acute hospitalisations because they often encounter adverse effects of hospitalisation, such as hospital-acquired illnesses, deterioration of functional capacity, and morbidity (Ouslander & Maslow, 2012). Nursing assessments and interventions provided in the long-term care facilities (LTCFs) are vital in reducing preventable acute hospitalisation of older people.
Aim: The aim of this study is to synthesise the literature in an integrative review on how nursing assessments and interventions may contribute to a reduction of preventable hospital transfers of older people from long-term care facilities.
Methods: Relevant papers were methodically searched from Science Direct, PubMed, CINAHL, Ovid MEDLINE, EMBASE and ProQuest databases. Following critical appraisal, a thematic narrative analysis was carried out and key findings extracted from which emergent themes and subthemes were synthesised.
Results: Seventeen studies met the inclusion criteria, covering the study period between 2008 and 2018. The analysis of findings identified key successful initiatives to reduce preventable hospitalisations among LTCF residents, using evidence-based clinical interventions including the provision of clinical support internally and externally, and which impacted LTCF staff decisions in transferring older residents to acute care hospital. Staff empowerment was essential in reducing preventable hospital admissions through upskilling of LTCF staff with educational programmes and tool training. Lastly, taking a proactive approach such as (i) Advanced Care Plan (ACP) Implementation, (ii) early GP Collaboration, and (iii) prevention initiatives which provide insight into the current nursing assessment and interventions provided in LTCFs.
Conclusion: Several interrelated variables influence the transfer of residents to acute hospitals, and these should be addressed by initiatives to decrease transfer. Proactive assessment and early intervention are critical to reducing acute hospitalisation.