Given the debate on LTC referrals, we wanted to examine the situation in our community in order to make changes or to quell the debate. The use of ambulances and emergency services for referrals puts unnecessary pressure on these services and is not cost effective. 15, 22 – 25 Studies of the elderly admitted to hospital report 22.9% 25 to 43.7% 26 of elderly experience 1 or more iatrogenic illnesses with potential for serious or fatal complications. 9, 15, 20 The elderly are also at greater risk of adverse events 21 and iatrogenic illness due to excessive diagnostic and therapeutic interventions. 18 Frail elderly are described by nurses as experiencing “transfer distress” 19 characterized by disorientation, confusion, rapid deterioration in condition, comorbidity, and the need for hospitalization.
Five domains of transfer have been identified, each with its own risks, communications challenges, possible inefficiencies, and duplications of care.
Referral with ambulance transfer from an LTC facility to an ED is an important clinical decision. 16 Estimates of “inappropriate referrals” range from 48% in the United States, 10 36% in the United Kingdom, 17 and 7% in Canada, 9 to less than 1% in Australia. One US study claims half (48.2%) of referrals are “avoidable.” 8 Recent investigations include audits of 1 LTC facility, 9 several LTC facilities, 10 – 14 and an ED, 15 and a population-level study. Three literature reviews on LTC referrals to EDs, 5 – 7 which are now decades old, reveal a range of research methods and report mostly descriptive findings. Their questions include the following: “Will the referral stabilize or improve the resident’s health status?” “What is the potential for ‘transfer distress’ and iatrogenic illness?” “Do advanced directives address the present problem?” “What is the position of the family?” Answers are not always clear or easy. For attending physicians, who typically make referral decisions, the issue is multifaceted: timely access to diagnostic tests, availability of nursing care in LTC facilities, and potential for benefit. 4 In Canada referral issues differ for each stakeholder: For LTC residents the issues include timeliness of care, personal and family preference, and potential for benefit. 3 Referral to EDs is deemed by some to be “dumping.” Australia recognizes the right of LTC residents to access emergency care and challenges the “myths and stereotypes” around referrals.
1 For more than 20 years, debate has simmered about the question “Are residents of LTC facilities sent appropriately to hospital emergency departments (EDs)?” In the United States, with its complex mix of private and public health care, the relationship between LTC and hospitals is adversarial, 2 reaching the status of an ethical debate.
#Fm 2009 Portuguese Ltc professional
In Canada long-term care (LTC) facilities provide residential accommodation for people who require on-site delivery of supervised care, including professional health services and personal care services (eg, meals, laundry, housekeeping), 24 hours a day.