title: Hospital admissions from nursing homes: a qualitative study of GP decision making.
abstract: BACKGROUND
  Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions.
  
  
  OBJECTIVE
  To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital.
  
  
  METHODS
  A purposive sample of 21 GPs from two counties in the South of England.
  
  
  METHODS
  Data from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method.
  
  
  RESULTS
  This study suggests that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable.
  
  
  CONCLUSIONS
  Developing a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.
authors.affiliation: Department of Primary Care and Population Science, University of Southampton, Southampton. crm20@soton.ac.uk
authors.forename: Clare
authors.initials: C
authors.lastname: McDermott
authors.forename: Richard
authors.initials: R
authors.lastname: Coppin
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Geraldine
authors.initials: G
authors.lastname: Leydon
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003657:Decision Making; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000523:psychology; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data*; D057240:Patient Preference; D010360:Patient Transfer; D016526:Workload; D055815:Young Adult