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Table 2 Summary of Themes for 8 or more cases

From: Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity

Residents’ Clinical Condition

Resident/Family Influences

NH Organizational Factors

Recurring acute diagnoses including sepsis, pneumonia, urinary tract infections, GI bleed, respiratory failure, DKA

Requests for transfers due to concerns about new clinical problems or exacerbations of chronic problems

Lack of NH resources to manage acute conditions such as need for suturing, management of acute illness

Chronic medical conditions including history of seizures, chronic pain, diabetes, ESRD, CHF, COPD, multiple sclerosis, Parkinson’s, stroke, anoxic brain injury

Missed opportunities between residents/families and staff for goals of care discussions and advance care planning

NH resources available, not accessed by staff such as APRNs not consulted prior to transfer

Repeat falls

  

Mental health history such as anxiety, depression, alcoholism, bipolar disorder

 

Lack of staff experience or comfort providing complex care such as managing tracheostomy tubes, feeding tubes, complex wounds

Chronic care needs including tracheostomies, wound care, colostomies, dialysis, central lines, foley catheters, suprapubic catheters, gastric feeding tubes

 

Missed nursing care such as missed assessment, not obtaining specimens, not obtaining vital signs

  1. GI Gastrointestinal, DKA Diabetic ketoacidosis, ESRD End stage renal disease, CHF Congestive heart failure, COPD Chronic obstructive pulmonary disease