Skip to main content Accessibility help
×
Home

Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments*

  • Margaret J. McGregor (a1) (a2) (a3), Riyad B. Abu-Laban (a2) (a4), Lisa A. Ronald (a1) (a2), Kimberlyn M. McGrail (a3) (a5), Douglas Andrusiek (a6), Jennifer Baumbusch (a7), Michelle B. Cox (a2), Kia Salomons (a2), Michael Schulzer (a8) and Lisa Kuramoto (a2)...

Abstract

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff – disproportionately present in publicly owned facilities – were associated with lower transfer rates. A number of other facility organizational characteristics – unrelated to ownership – were also associated with transfer rates.

Cette étude a examiné comment la propriété des maisons de soins infirmiers porte sur les taux de transfert des services urgences (SU), comment les caractéristiques organisationnelles des installations sont réparties entre les groupes de propriété, et comment ces caractéristiques sont associées aux taux de transfert SU. L’échantillon comprenait une cohorte rétrospective de résidents des maisons de soins infirmiers dans la région de Vancouver Coastal Health (n = 13,140). Les taux de transferts SU ont été comparés entre les différents types de propriété des foyers de soins. Pour une analyse exploratoire, des données administratives ont ensuite été liées aux données provenant d’enquêtes auprès des caractéristiques organisationnelles des installations. Taux de transfert brut (SU transferts/100 ans résidents) étaient de 69, 70 et 51, respectivement, dans les installations à but lucratif, celles à but non-lucratif et les installations publiques. Avec des contrôles pour le sexe et l’age, la propriété publique a été associée aux taux de transfert SU inférieurs à ceux des installations à but lucratif et sans but lucratif. Les résultats ont aussi démontré un montant total plus élevé associé aux heures de soins directs infirmières par journée/résident, et la présence de personnel de Allied Health – qui sont présents de manière disproportionnée dans les installations de propriété publique – ont été associés aux taux de transfert inférieurs.

Copyright

Corresponding author

Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Margaret J. McGregor, M.D., M.H.Sc. Department of Family Practice University of British Columbia Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8 (mrgret@mail.ubc.ca)

Footnotes

Hide All
*

We gratefully acknowledge the following individuals: Jan Volker, M.Ed., who administered the nursing home facility survey; Judith Globerman, Ph.D., who provided valuable input into the study design and facility survey administration; Penny Brasher, biostatistician at the Vancouver Coastal Health Research Institute’s (VCHRI) Centre for Clinical Epidemiology and Evaluation who oversaw earlier versions of the data analyses; Susan Sirrett, Patricia Chung, and Colin Sue (VCH Decision Support), Carole Astley and Catherine Barnardo (Fraser Health Decision Support), and Karl Newholm and Areta Wong (Providence Health Care Decision Support) who assisted in data extraction from their respective administrative databases; Edwin Mak, who assisted with database management; Stirling Bryan, head of the VCHRI’s Centre for Clinical Epidemiology and Evaluation who contributed to interpreting the data; and the librarians of the BC College of Physicians and Surgeons Library who assisted with literature searches. This study was supported by a grant from the Vancouver Foundation (operating grant 2008–2011), the UBC Department of Family Practice Division of Geriatrics, and the VGH Department of Family Practice. Margaret McGregor was supported by a Community-Based Clinician Investigator Award from the Vancouver Foundation (2007–2011).

Footnotes

References

Hide All
Abu-Laban, R. B. (2006). The junkyard dogs find their teeth: Addressing the crisis of admitted patients in Canadian emergency departments. Canadian Journal of Emergency Medicine, 8(6), 388391.
Ackermann, R. J., & Kemle, K. A. (1998). The effect of a physician assistant on the hospitalization of nursing home residents. Journal of the American Geriatrics Society, 46(5), 610614.
Allman, R. M., Laprade, C. A., Noel, L. B., Walker, J. M., Moorer, C.A., Dear, M. R., et al. (1986). Pressure sores among hospitalized patients. Annals of Internal Medicine, 105(3), 337342.
American Health Care Association, Research and Reimbursement Department. (2010). Trends in nursing facility characteristics. Retrieved 9 September 2011 from http://www.ahcancal.org/research_data/trends_statistics/Documents/trends_nursing_facilities_characteristics_Dec2010.pdf.
Barry, T. T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45(3), 309317.
British Columbia Ministry of Health. (2011). Home and community care policy manual. Retrieved September 9, 2011, from http://www2.gov.bc.ca/gov/topic.page?id=8F569BDA913540DCAB75145DBB6070CE.
Berta, W., Laporte, A., & Valdmanis, V. (2005). Observations on institutional long-term care in Ontario: 1996-2002. Canadian Journal on Aging, 24(1), 7184.
Bottrell, M. M., O’Sullivan, J. F., Robbins, M. A., Mitty, E. L., & Mezey, M. D. (2001). Transferring dying nursing home residents to the hospital: DON perspectives on the nurse’s role in transfer decisions. Geriatric Nursing, 22(6), 313317.
Bravo, G., Charpentier, M., Dubois, M. F., DeWals, P., & Emond, A. (1998). Profile of residents in unlicensed homes for the aged in the eastern townships of Quebec. Canadian Medical Association Journal, 159(2), 143148.
Carter, M.W., & Porell, F.W. (2005). Vulnerable populations at risk of potentially avoidable hospitalizations: The case of nursing home residents with Alzheimer’s disease. American Journal of Alzheimer’s Disease and other dementias, 20(6), 349358.
Casarett, D., Karlawish, J., Morales, K., Crowley, R., Mirsch, T., & Asch, D. A. (2005). Improving the use of hospice services in nursing homes: A randomized controlled trial. JAMA, 294(2), 211217.
Castle, N. G. (2001). Administrator turnover and quality of care in nursing homes. The Gerontologist, 41(6), 757767.
Castle, N. G., & Lin, M. (2010). Top management turnover and quality in nursing homes. Health Care Management Review, 35(2), 161174.
Comondore, V. R., Devereaux, P. J., Zhou, Q., Stone, S. B., Busse, J. W., Ravindran, N. C., et al. (2009). Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. British Medical Journal, 339, b2732.
Decker, F. H. (2008). The relationship of nursing staff to the hospitalization of nursing home residents. Research in Nursing and Health, 31(3), 238251.
Dosa, D. (2005). Should I hospitalize my resident with nursing home-acquired pneumonia? Controversies in Long-term Care, 6(5), 327333.
Doupe, M., Brownell, M., Kozyrskyj, A., Dik, N., Burchill, C., Dahl, M., et al. (2006). Using administrative data to develop indicators of quality care in personal care homes. Manitoba, Canada: Manitoba Centre for Health Policy, Dept of Community Health Sciences, Faculty of Medicine, University of Manitoba.
Fried, T. R., Gillick, M. R., & Lipsitz, L. A. (1997). Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer. Journal of the American Geriatric Society, 45(3), 302306.
Frohlich, N., De Coster, C., & Dik, N. (2006). Estimating personal care home bed requirements. Manitoba, Canada: Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba.
Gillick, M. R., Serrell, N. A., & Gillick, L. S. (1982). Adverse consequences of hospitalization in the elderly. Social Science and Medicine, 16(10), 10331038.
Harnett, C. E. (2012). Overcrowding at Royal Jubilee hits highest level: Seven ambulances in queue, 28 patients await beds. Retrieved 9 June 2012 from http://www.vancouversun.com/health/Overcrowding+Royal+Jubilee+hits+highest+level/6255084/story.html.
Harrington, C., Woolhandler, S., Mullan, J., Carrillo, H., & Himmelstein, D. U. (2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health, 91(9), 14521455.
Hillmer, M. P., Wodchis, W. P., Gill, S. S., Anderson, G. M., & Rochon, P. A. (2005). Nursing home profit status and quality of care: Is there any evidence of an association? Medical Care Research & Review, 62(2), 139166.
Horn, S. D., Buerhaus, P., Bergstrom, N., & Smout, R. J. (2005). RN staffing time and outcomes of long-stay nursing home residents: Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care. American Journal of Nursing, 105(11), 5870.
Hutt, E., Ecord, M., Eilertsen, T. B., Frederickson, E., & Kramer, A. M. (2002). Precipitants of emergency room visits and acute hospitalization in short-stay medicare nursing home residents. Journal of American Geriatrics Society, 50(2), 223229.
Hutt, E., Frederickson, E., Ecord, M., & Kramer, A. M. (2003). Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Journal of American Medical Directors Association, 4(4), 195199.
Intrator, O., Castle, N. G., & Mor, V. (1999). Facility characteristics associated with hospitalization of nursing home residents: Results of a national study. Medical Care, 37(3), 228237.
Intrator, O., Zinn, J., & Mor, V. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of American Geriatrics Society, 52(10), 17301736.
Kramberger, A. (2012). ER overcrowding a priority for health centre, chief says. Retrieved 11 March 2012 from http://www.edmontonjournal.com/health/overcrowding+priority+health+centre+chief+says/6438714/story.html.
Mah, R. (2009). Emergency department overcrowding as a threat to patient dignity. CJEM, 11(4), 365374.
McGregor, M. J., Baumbusch, J., Abu-Laban, R. B., McGrail, K. M., Andrusiek, D., Globerman, J., et al. (2011). A survey of nursing home organizational characteristics associated with potentially avoidable hospital transfers and care quality in one large British Columbia health region. Canadian Journal on Aging, 30(4), 551561.
McGregor, M., Pare, D., Wong, A., Cox, M. B., & Brasher, P. (2010). Correlates of a “do not hospitalize” designation: In a sample of frail nursing home residents in Vancouver. Canadian Family Physician, 56(11), 11581164.
McGregor, M. J., & Ronald, L. A. (2011). Residential long-term care for Canadian seniors: Non-profit, for-profit or does it matter? Montreal: IRPP Institute for Research in Public Policy.
McGregor, M. J., Tate, R. B., McGrail, K. M., Ronald, L. A., Broemeling, A. M., & Cohen, M. (2006). Care outcomes in long-term care facilities in British Columbia, Canada. Does ownership matter? Medical Care, 44(10), 929935.
McGregor, M. J., Tate, R. B., Ronald, L. A., McGrail, K. M., Cox, M. B., Berta, W., et al. (2010). Staffing in long-term care in British Columbia, Canada: A longitudinal study of differences by facility ownership, 1996–2006. Health Reports, 21(4), 17.
Molloy, D. W., Guyatt, G. H., Russo, R., Goeree, R., O’Brien, B. J., Bedard, M., et al. (2000). Systematic implementation of an advance directive program in nursing homes: A randomized controlled trial. JAMA, 283(11), 14371444.
O’Neill, C., Harrington, C., Kitchener, M., & Saliba, D. (2003). Quality of care in nursing homes: An analysis of relationships among profit, quality, and ownership. Medical Care, 41(12), 13181330.
Provincial Emergency Services Advisory Panel. (2009). Improving access to quality care for emergency department patients in British Columbia. Retrieved 9 June 2012 from http://www.health.gov.bc.ca/cpa/mediasite/pdf/report-of-the-ed-decongestion-expert-panel.pdf.
Quach, C., McArthur, M., McGeer, A., Li, L., Simor, A., Dionne, M., et al. (2012). Risk of infection following a visit to the emergency department: A cohort study. CMAJ, 184(4), E232E239.
Ramage-Morin, P. L. (2006). Successful aging in healthcare institutions (Report No. 82–003). Supplement to Health Reports, Volume 16. Ottawa, ON: Statistics Canada.
Rantz, M. J., Hicks, L., Grando, V., Petroski, G. F., Madsen, R. W., Mehr, D. R., et al. (2004). Nursing home quality, cost, staffing, and staff mix. The Gerontologist, 44(1), 2438.
Reid, R. C., & Chappell, N. L. (2003). Staff ratios and resident outcomes in special care units: Do activity aides make a difference? Journal of Applied Gerontology, 22(1), 89103.
Schull, M. J. (2006). Hospital surge capacity: If you can’t always get what you want, can you get what you need? Annals of Emergency Medicine, 48(4), 389390.
Schull, M. J., Kiss, A., & Szalai, J. P. (2007). The effect of low-complexity patients on emergency department waiting times. Annals of Emergency Medicine, 49(3), 257264.
Shapiro, E., & Tate, R. B. (1995). Monitoring the outcomes of quality of care in nursing homes using adminstrative data. Canadian Journal of Aging, 14(4), 755768.
Tang, M., Woo, J., Hui, E., Chan, F., Lee, J., Sham, A., et al. (2010). Utilization of emergency room and hospitalization by Chinese nursing home residents: A cross-sectional study. Journal of Americal Medical Directors Association, 11(5), 325332.
Young, Y., Barhydt, N. R., Broderick, S., Colello, A. D., & Hannan, E. L. (2010). Factors associated with potentially preventable hospitalization in nursing home residents in New York state: A survey of directors of nursing. Journal of American Geriatrics Society, 58(5), 901907.
Zimmerman, S., Gruber-Baldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. (2002). Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors. Journal of the American Geriatric Society, 50(12), 19871995.

Keywords

Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments*

  • Margaret J. McGregor (a1) (a2) (a3), Riyad B. Abu-Laban (a2) (a4), Lisa A. Ronald (a1) (a2), Kimberlyn M. McGrail (a3) (a5), Douglas Andrusiek (a6), Jennifer Baumbusch (a7), Michelle B. Cox (a2), Kia Salomons (a2), Michael Schulzer (a8) and Lisa Kuramoto (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed