Methods: Phase 1 involved in-depth individual and focus group interviews in 6 LTC facilities in Alberta, Canada. The sample consisted of 71 Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Healthcare Aides, managers, and family members of LTC residents, in addition to 9 regional Emergency Medical Services (EMS) Personnel. Thematic analysis of 25 interviews and 19 focus groups followed. In Phase 2, an online survey was administered to staff and physicians in 18 LTC facilities and regional EMS personnel (N=351) to verify the findings of Phase 1. Descriptive analysis was undertaken of the survey data completed by the working sample: 50 RNs and physicians in an ED; 137 paramedics and EMTs; 142 RNs, LPNs, and administrators in LTCs; and 22 LTC Medical Directors.
Results: The results led to an inductively developed conceptual definition of avoidable transfers. The identification of primary factors contributing to avoidable LTC-ED transfer decisions included: healthcare providers’ lack of familiarity with residents, a shortage of diagnostic and treatment resources in LTCs, limitations in the staff-family relationship, and varied interpretations of the Advance Care Planning policy. Emergent themes included: fear of liability; staff & family relationships; interpreting Goals of Care Designations; knowing the resident; healthcare provider’s critical thinking & response to ambiguity; limited diagnostic & treatment options in LTC; access to a second opinion.
Conclusion: The implications of these findings lead to recommendations for changes to policies and the development of decision-making guidelines regarding LTC-ED transitions.