Nursing Home Abuse: Communication problems often contribute to untimely care of acute infections
in nursing homes
September 2004 (www.ahrq.gov)
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Quick diagnosis and management of acute infections among nursing home
residents require successful communication at multiple levels. However,
communication breakdowns are common, and they create barriers to timely care of
acute infections in nursing home residents, according to a study supported in
part by the Agency for Healthcare Research and Quality (HS08551). Researchers
from the University of Missouri-Columbia analyzed discussions of focus groups of
nursing home physicians and nurses and interviews with nursing home residents,
nurses, and physicians involved in acute illness care. Their goal was to
identify factors that promoted or delayed timely identification and treatment of
residents' acute infections.
The interviews revealed 22 factors that influenced timeliness of effective
care, with communication problems commanding the central focus. Six
communication barriers stood out: failure of the physician to receive a message;
evening or weekend illness onset, problems in contacting the on-call physician;
reliance on an intermediary (for example, an office nurse) to convey orders from
the physician; communication of inappropriate or inaccurate information;
inadequate information transfer between nursing staff at shift changes; and a
nurse's reluctance to talk with a physician perceived as difficult.
Focusing on these communication barriers may improve quality of care for
acute infections in nursing home residents, suggest the researchers. More
effective teamwork between physicians and nurses can improve care and avoid
residents being unnecessarily transferred to the hospital for the treatment of
acute illnesses. This approach could also save health care costs by intervening
earlier in the causal chain that leads to hospitalization and poor outcomes in
acute illness among nursing home residents.
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