Development and testing of a standardized communication form to improve transitions for nursing home residents
A communication form was developed and pilot-tested in a sample of transitions from nursing homes to the emergency department and back. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Research Results
Findings: (1) A finding with significant implications for the future success of this communication form is that one of the two pages is often lost. As such, we have recommended to AHS that the two pages be joined on their long (vertical) edge and open like a book. AHS has verbally confirmed that this change will be adopted. (2) 90 forms were collected during the study implementation period. The two-page communication form was used in approximately 39% of transfers identified by the research assistants. 65% of forms collected had the LTC sending information section completed in whole or in part. 17% of forms were filled out in whole or in part by care providers in more than one care setting. An additional 18% of forms were spoiled, as they were missing one of the two required pages.
Impact of findings: The inter-facility patient transfer form is being launched provincially by Alberta EMS and is expected to be used for all patient transfers. Upon recommendation from the research team, Alberta Health Solutions has joined the two pages of the IFPT form along the long edge so that it is more difficult to lose one of the two pages (as happened in 18% of pilot study cases).
Publications, presentations and webinars
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About the Project
One of the key findings from the Older Persons’ Transitions in Care (OPTIC) study is the need to improve communication among health care providers involved in the handover of frail elderly residents during transfers to and from the emergency department. These transitions from long term care to emergency departments and back are facilitated by personnel from emergency medical services, long-term care and the emergency department.
Considering the many different types of healthcare personnel involved in these handovers, some information as simple as whether a resident owns eyeglasses, dentures, walking aids, etc. is often missed in documentation. Thereby, these personal assistive devices may not accompany the resident to the emergency department and back or possibly become lost during the transition. This failure to protect the vulnerable elderly resident and their belongings can leave them frightened and feeling unable to communicate at their assisted capacity.
Based on the pilot-test mentioned above, we hoped to confirm that a communication form used by all health care providers during transitions of care improves communication, resulting in better care for the frail elderly resident.
For more details on the project rationale and objectives, click here.
Project Team
Principal Investigator:
Greta Cummings, PhD, RN, FCAHS — University of Alberta
Co-Investigators:
Garnet Cummings, BPE, MSc, FRCP, FACEP, EMDM — University of Alberta
Carole Estabrooks, RN, PhD, FCAHS — University of Alberta
Colin Reid, PhD, MA, BA — University of British Columbia
Brian Rowe, MSc, CCFP(EM), MD, BSc — University of Alberta
Adrian Wagg, MB, BS, FRCP, FHEA(MD) — University of Alberta
Knowledge Users and Partners:
Carol Anderson, MScN — Baycrest Centre for Geriatric Care
Ann Chiovetti, RN, BN, MHS — Alberta Health Services
Karen Latoszek, RN, ENC(c) — Alberta Health Services
Lorie-Ann Little — National Initiative for the Care of the Elderly
Garnet Munro, MBA — Alberta Health Services
Project Contact: Greta Cummings — gretac@ualberta.ca
CAT 2013-43
Key words: transitions; communication; continuity of care; nursing homes; emergency department
A communication form was developed and pilot-tested in a sample of transitions from nursing homes to the emergency department and back. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Project Contact: Greta Cummings — gretac@ualberta.ca
Key Findings for Families
- The form was used in 90 of 247 patients transferred during the study period
- Emergency room and paramedic staff mostly felt the form helped them provide better care, but rarely filled out the form in practice
- Long-term care (LTC) staff filled out the form more often than paramedics and emergency staff, but found that the form took too much time and effort to complete
- Some information about residents’ belongings or allergies were recorded more often in this study than in earlier studies
Why This Matters
When older persons are moved to and from LTC and the emergency department (ED), many healthcare workers take care of them during the move. Because of this, some things can be missed in the paperwork, such as whether the person has glasses or dentures. We tested a new Alberta Health Services transfer form to see if it helped with communication.
Using the same transfer form might help relay important information, such as you or your loved one’s allergies, medication history and you or your loved one’s ability to walk or speak. This can help healthcare workers provide better care and can save a life in an emergency.
About This Study
- We studied transfers of LTC residents to the ED, by paramedics, and back again
- Our goals were to:
- test the new Alberta Health Services Inter-Facility Patient Transfer form
- learn healthcare providers’ opinions of the usefulness of the form in practice
- assess how often and how well the form was used
- Research Assistants trained staff to use the new transfer form on night and day shifts at study sites, and sent training materials to paramedics by e-mail. Research Assistants collected forms from the emergency department and again when residents came back to LTC. Staff in all settings filled out surveys before and after the form was tested
A communication form was developed and pilot-tested in a sample of transitions from nursing homes to the emergency department and back. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Project Contact: Greta Cummings — gretac@ualberta.ca
Key Findings for Policy
- A province-wide patient transfer form was used in 90 of 247 (36.4% uptake) resident transitions, across the 11 long-term care facilities, over an eight-month period. Uptake varied dramatically by site and setting
- Emergency room and emergency medical services (EMS) staff scored transfer more favourably when the form was used compared to when the form was not used, but rarely completed the form in practice
- Long-term care staff completed the form more often than EMS and emergency room staff
- Long-term care staff reported finding the form burdensome in light of the time and effort they invested in completing it
- Some information, like details of residents’ personal effects, was recorded more frequently when the form was used than in previous research
Why This Study was Needed
Transitions from long-term care (LTC) to emergency departments (EDs) and back involve EMS, LTC and the ED. Considering the many different types of healthcare personnel involved in these handovers, some information, as simple as whether a resident owns eyeglasses, dentures, walking aids, etc. is often missed in documentation. We pilot tested a new Alberta Health Services Inter-Facility Patient Transfer form, to accompany LTC residents, to see if it improved communications among healthcare providers during transitions.
Future efforts in implementation of innovation in health care should balance the work load required between sites/providers, and the benefits that the intervention offers to operators/providers. Site and healthcare practitioner engagement should be a major focus at the outset and throughout the lifecycle of any innovation project.
Study Summary
- We studied transitions of LTC residents to the ED via EMS, and back again
- Our objectives were to:
- pilot test the new Alberta Health Services Inter-Facility Patient Transfer form
- measure healthcare providers’ opinions of the usefulness of the form to their practice
- assess how often and how well the form was used
- Research Assistants provided training on the new transfer forms to night and day shift staff in study sites, and to EMS through emailed materials
- Research Assistants collected forms from the ED and again on residents’ return to the LTC. Surveys were conducted with staff in all settings before and after the introduction of the form
A communication form was developed and pilot-tested in a sample of transitions from nursing homes to the emergency department and back. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Project Contact: Greta Cummings — gretac@ualberta.ca
Key Findings for Researchers
- The form was used in 90 of 247 resident transitions, captured by data collectors across the 11 participating long-term care (LTC) facilities, over an eight-month period, February 25 – October 30, 2015. This is 36.4% form uptake. Uptake varied dramatically by site and setting
- Emergency department (ED) and emergency medical services (EMS) staff scored transfers where the form was used higher than transfers where the form was not used, but rarely completed the form in practice
- LTC staff completed their portion of the form more often than EMS and ED staff, but scored transfers without the form higher than transfers with the form in the post-survey. LTC staff reported finding the form burdensome in light of the time and effort they invested in completing it
- Some information, like details of residents’ personal effects, was recorded more frequently when the form was used than in previous research
Dissatisfaction with communications between healthcare settings may negatively impact patient care.
- Since Alberta Health Services is introducing the form throughout Alberta, future studies may examine whether satisfaction with communication of information on the transfer form is correlated with better patient outcomes
- The form includes information on patient allergies and medication information. Future studies may assess whether the introduction of the form corresponds with a reduction in allergy and medication related adverse events
- One of the findings of the previous Older Persons’ Transitions in Care (OPTIC) study is that patients often return to the LTC from the ED without being treated. The form may prevent this outcome, by allowing LTC facilities to better communicate the reason for the transfer to the ED. Future studies may examine whether rates of return to LTC with no treatment decline relative to OPTIC baseline data
Why This Study was Needed
Transitions from LTC to EDs and back are facilitated by personnel from EMS, LTC and the ED. Considering the many different types of healthcare personnel involved in these handovers, some information as simple as whether a resident owns eyeglasses, dentures, walking aids, etc. is often missed in documentation. We pilot-tested a two page communication form in a sample of these transitions.
Study Summary
We studied transitions of LTC residents over the age of 65 to the ED via EMS, and back again. Our objectives were to (1) pilot test the new Alberta Health Services Inter-Facility Patient Transfer form, (2) measure healthcare providers’ (HCP) assessment of feasibility of use, usefulness and applicability of information included in the form to their practice and (3) assess rates of form and data element completion. Research Assistants provided training on the new transfer forms to night and day shift staff in study sites, and to EMS through emailed materials. Research Assistants collected forms from the ED and again on residents’ return to the LTC. Pre- and post-surveys were conducted with staff in all settings.
Future Research
- Reasons for low uptake of the form throughout the participating healthcare settings remain to be explored; for example, through qualitative interviews
- This pilot project focused on the impact of the form on communication between healthcare settings. Impacts of the form on patient outcomes remain to be explored
A communication form to pilot-test in a sample of transitions from nursing homes to the emergency department and back has been developed. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Principal Investigator
Greta Cummings, RN, PhD — University of Alberta
Webinars
Development and testing of a standardized communication form to improve transitions for nursing home residents — Greta Cummings
A communication form pilot-test in a sample of transitions from nursing homes to the emergency department and back has been developed. Elements of the communication form were informed by previous research and include essential medical information, reference to documents and personal assistive devices.
Principal Investigator
Greta Cummings, RN, PhD — University of Alberta
Rationale: Considering the many different types of healthcare personnel involved in these handovers, some information as simple as whether a resident owns eyeglasses, dentures, walking aids, etc. is often missed in documentation and thus may not accompany the resident to the ED and back. This failure to protect the vulnerable elderly resident and their belongings can leave them frightened and feeling unable to communicate at their assisted capacity.
Objectives: (1) pilot-test a two-page standardized communication form throughout LTC-EMS-ED transitions and return, in Alberta OPTIC study sites, (2) assess healthcare providers’ (HCP) assessment of feasibility of use, usefulness and applicability of information to their practice, (3) assess rates of form and data element completion and (4) examine documentation rates of a) resident information, b) documents attached and c) assistive devices accompanying LTC residents throughout their transition, compared to data examined in the previous Older Persons Transitions in Care (OPTIC) study focusing on Alberta transitions (via proof of principle).