title: Decisions about transferring nursing home residents to hospital: highlighting the roles of advance care planning and support from local hospital and community health services.
abstract: OBJECTIVE
  To explore current practice and opportunities to improve practice in decision-making about transfer of nursing home residents to hospital.
  
  
  BACKGROUND
  Nursing home staff are often faced with the decision of whether to send a resident to hospital for medical treatment. While many residents will benefit from going to hospital, there are also several risks associated with this. This study sought to add to the existing body of research on this issue by seeking the views of nursing home managers, who are the persons most frequently involved in making these decisions.
  
  
  METHODS
  Qualitative design using purposive, quota sampling.
  
  
  METHODS
  Qualitative interviews with 41 nursing home managers from south-western Sydney, Australia.
  
  
  RESULTS
  Factors affecting the decision to transfer a resident to hospital include acuteness of their condition; level and style of medical care available; role of family members; numbers, qualifications and skills mix of staff; and concern about criticism for not transferring to hospital. Two factors that have not featured as strongly in previous research are the roles of advance care planning and support from local hospital and community health services.
  
  
  CONCLUSIONS
  While transferring a nursing home resident to hospital is often necessary, there are many situations where they could be cared for in the nursing home; therefore, avoid complications associated with being in hospital. Apart from a range of factors already identified in the literature, this study has highlighted the important role that advance care planning and support from local health services can play in reducing unnecessary transfers to hospital.
  
  
  CONCLUSIONS
  There are several strategies that nursing homes and local health authorities can adopt to promote advance care planning and build better support systems between the two sectors, thereby reducing the numbers of residents who need to be transferred to hospital for their health care.
authors.affiliation: Aged Care Research Unit, Liverpool Hospital, University of New South Wales, Sydney, Australia. Christopher.Shanley@sswahs.nsw.gov.au
authors.forename: Christopher
authors.initials: C
authors.lastname: Shanley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Whitmore
authors.forename: David
authors.initials: D
authors.lastname: Conforti
authors.forename: Janine
authors.initials: J
authors.lastname: Masso
authors.forename: Sanjay
authors.initials: S
authors.lastname: Jayasinghe
authors.forename: Rhonda
authors.initials: R
authors.lastname: Griffiths
mesh_terms: D032722:Advance Care Planning; D002983:Clinical Competence; D003153:Community Health Services / Q000458:organization & administration*; D006739:Hospital Administration; D006760:Hospitalization; D009735:Nursing Homes; D010360:Patient Transfer; D010561:Personnel Staffing and Scheduling