Prevention of Acute Hospital Transfers for Long-Term Care Residents at the End of Life.

Abstract

BackgroundLong-term care (LTC) residents continue to be acutely transported to the hospital at the end of life (EOL). This frail and dependent population are known to have multiple chronic conditions with more acute and complex medical care needs, which places them at risk for frequent transfers to the hospital. When these multifactorial events transpire at the EOL, they are deemed inappropriate in terms of patient care and healthcare costs. Yet these costly, unnecessary and burdensome transitions still occur, regardless of adverse clinical outcomes and jeopardizing the quality of EOL care provided to LTC residents.ObjectiveTo highlight the burdensome impact acute hospital transfers have on LTC residents at the EOL with the detriment to quality of life and care, in addition to providing strategies to prevent these unnecessary events.FindingsLong-term care residents are a vulnerable population with advanced comorbidities who often require high acuity care and are subject to preventable transfers to the hospital at the EOL. These disruptions in EOL care cause harm and complications, negatively impacting quality of care. The consequences of these events can be mitigated with early advance care planning to include documentation of EOL care goals, onsite medical clinicians to make critical decisions and provide care within LTC facilities, and adequate staffing with proper palliative and hospice care training.ConclusionImmediate action is needed to advocate for this high risk population and implement interventions to prevent hospital transfers at the EOL, therefore improving quality of care and positively influencing LTC residents' EOL experience.