Addressing unnecessary and avoidable transfers from residential aged care to emergency departments and hospitals.

Abstract

Purpose The purpose of this article is to examine and discuss the literature regarding emergency department (ED) transfers from residential aged care with a focus on reducing potentially avoidable transfers to enhance care experiences, safety, and outcomes. Design Researchers experienced in evidence synthesis and policy research in the aged care space reviewed the literature about residential aged care transfers to EDs, including factors underlying transfers and interventions to reduce transfers. Findings Transfers to EDs from aged care are common. They can be harmful, distressing, costly, and have a variety of negative impacts on residents, staff, and the aged care and health system. High rates of potentially avoidable or unwarranted transfers suggests the presence of systemic issues, including the lack of sufficient staffing levels and skills mix with the requisite knowledge, training, resources, and support. Reforms are required to improve staffing levels and skills mix, enhance access to on-site and in-reach clinical expertise, provide access to quality improvement initiatives, and engage consumers to ensure shared decision-making. Further research is also required to help determine the best approach to reducing unnecessary hospital transfers from aged care considering the specific scopes of practice of aged care workers. Conclusion While some transfers from residential aged care to EDs are necessary, many do not represent safe, dignified care for older people. Unwarranted transfers are burdensome and risky and should be minimised through the provision of a range of reforms including sufficient staffing, resources, and support, that allow for the delivery of care in place where appropriate.