This qualitative study, undertaken in Western Australia, explores factors that influence decision-making as to whether to transfer elderly people in residential care homes to the emergency department (ED) for acute medical problems. A total of 33 stakeholders participated in three focus groups: family members (n=5), GPs (n=4), carers (n=7), care-home managers (n=5), nurses working in the care home (n=5); and ED staff (n=7). In addition, semi-structured interviews were carried out with nine residents who had previous experience of being transferred to the ED for an acute medical problem.
Five key themes emerged from the focus groups with parallel findings being identified in the individual interviews: inadequate staffing levels and skill mix of staff working in the residential aged care facilities (RACF); issues around available treatment options; challenges to effective management of end-of-life issues; difficulties with communication between the different agencies i.e. RACF, ED and GP; excessive bureaucratic requirements. Of the nine residents who participated, seven identified that they would prefer to be treated in the care home if at all possible.
The authors identify ‘solutions’ to some of these challenges including implementation of a mobile clinical team to attempt to reduce demand for transfer to ED. However, this is a small-scale study and, as such, the findings are not generalisable, although they may well be transferable. Further research is required to assess safety, clinical efficacy, and cost-effectiveness of the proposed recommendations for this patient group.