Support teams key to reducing hospitalizations from nursing homes
Nursing home residents are often cared for by a variety of health care professionals, including licensed nursing staff. Transfers to a hospital can result from multiple factors, such as recurrent falls or medication mismanagement.
Now, researchers at the University of Missouri have found that providing advanced practice registered nurses with a multidisciplinary support team can help drastically reduce avoidable hospitalizations for nursing home residents.
Amy Vogelsmeier and Lori Popejoy, associate professors in the MU Sinclair School of Nursing, co-led the practice component of the Missouri Quality Initiative, a program that embedded full time advanced practice registered nurses in nursing homes with the goal to reduce avoidable hospitalizations. The support team consisted of clinical experts in nursing home care that support the work of the advanced practice registered nurses.
This team, including highly trained nurses, a social worker, medical director and health information coordinator, mentored the advanced practice registered nurses in their role and supported efforts of the nursing home leaders by providing feedback reports. Serving in 16 nursing homes throughout the Midwest with higher hospitalization rates than the national average, the program has resulted in a 30% reduction in hospital admissions since 2012.
"The support team influences care delivery by coaching the advanced practice registered nurses to in turn coach and mentor nursing home staff to identify when patients are getting ill and then ensuring the proper resources are in place to allow the patients to be cared for at the nursing home instead of sending them to a hospital," Vogelsmeier said. "By identifying patterns that contribute to hospitalizations, the support team of clinical experts can enhance the advanced practice registered nurses' ability to elevate the quality of care and ultimately improve health outcomes."
In addition to recognizing patterns that lead to hospitalizations, the support team provides best practices in areas like fall risk management, difficult discussions near end of life and ensuring that high risk medications are used appropriately. These practices can then be translated to other nursing homes nationwide, resulting in reduced hospitalizations.
"The support team is helping the advanced practice registered nurses put systems in place to facilitate staff growth and development at the nursing home so they can manage care appropriately 24 hours a day," Popejoy said. "Whether it's the physicians, nurses, nursing assistants, nursing home administrators, staff development coordinators or directors of nursing, none of us are as smart as all of us."
"Reducing Avoidable Hospitalizations for Nursing Home Residents: Role of the Missouri Quality Initiative Intervention Support Team" was recently published in Journal of Nursing Care Quality. Funding was provided by The Center for Medicare and Medicaid Innovation Center.