As many of us know, older adults in the Long-Term Care (LTC) setting often have conditions or cognitive impairment that limits their ability to advocate for themselves and to effectively communicate their care needs. This often leads to incomplete and inconsistent documentation, especially when residents are transferred to the Emergency Department (ED) for care as they often cannot assist with filling in the blanks when it comes to their care, medications, treatment, etc. A team of researchers in Canada recognized how vital information continuity is and conducted the Older Person’s Transitions in Care (OPTIC) study. This study, funded by the Canadian Institutes of Health Research, aimed to develop a tool that measures successful transitions of care. The team evaluated each resident’s condition while in the LTC setting, EMS (emergency transport via ambulance), and while in the ED.
The OPTIC study analyzed the transitions of 524 LTC residents 65 years of age and older living in 38 Canadian nursing homes that occurred over a 12-month period. The trigger event leading to a transfer from LTC, comorbidities, EMS chief complaint, ED chief complaint, and ED diagnoses records were examined for each resident. The transition documents from the cohort were reviewed and marked as either being consistent or inconsistent; the cases that did not fit either category were marked as ambiguous.
Consistent resident transitions were defined as those that included a transfer reason that aligned with what was reported at the ED. Inconsistent transfers included trigger events and diagnoses that did not align across the transition from LTC-ED-LTC. From the 524-resident cohort, 33 transitions were missing data from at least one care setting, and in 13 resident cases, the resident or a family member had requested the ED transfer. The researchers observed that “as older adults may present with unclear or atypical symptoms for serious changes in health condition, precise and informative documentation is critical to direct effective care that combats the potential effects of discrimination against older adults who may be unable to advocate for themselves.”1
The inconsistent documentation often reflected a change in a resident’s condition or atypical symptom presentation. “In 61% of those with insufficient reporting, the chief resident complaint was not reported, or marked as ‘transfer’ or ‘no patient care record.’” 1 The researchers were surprised by the large number of transitions (n=124) in the inconsistent and ambiguous cases that reported “sudden change in condition” which is insufficient information to provide care.1 The data shows that roughly one-third of the residents’ transition records from LTC to the ED contained issues with documentation and or discrepancies. It is unclear from the collected data if the discrepancies were caused by varying expectations among healthcare professionals in different settings or possibly a difference in the healthcare provider’s education.
This study demonstrates the need for accessible, consistent data throughout the LTC residents’ transition of care process. Implementing documentation that support a geriatric focus-centered approach and considering the different approaches of health care professionals would help to develop the best practices for such documentation. Improved documentation will lead to better resident care and ultimately reduce the number of unnecessary transitions.