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Related Concept Videos

Documentation in Long-Term and Home Healthcare Setting01:29

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The planning phase of the nursing process helps nurses set priorities, outline patient-centered goals and expected outcomes, and tailor nursing interventions to align with the aligned care plan. Through the planning phase, the nurse applies critical thinking skills to align and develop interventions according to the patient's needs. It provides continuity of care allowing patients to receive the maximum benefit from treatment. It serves as a pilot plan for allocating individual staff to a...
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Establishing a secure, collaborative nurse-patient relationship is crucial for delivering high-quality care. This relationship, founded on trust, respect, and honesty, enhances the patient's comfort and willingness to share vital health information. For example, a nurse who listens actively and without judgment provides clear information about health conditions and treatment options and respects patient decisions, which builds a trusting relationship.
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Ethical Dilemmas II01:30

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Resolving an ethical dilemma in healthcare involves a systematic approach that considers every aspect of the issue, respecting both the patient's needs and values and the healthcare professional's ethical obligations. Here are potential steps to resolve an ethical dilemma:
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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Related Experiment Video

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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Collaborative Working to Address Inappropriate ED Attendances by Nursing Home Residents.

Mary McCarthy1, Patricia Sheahan2

  • 1University Hospital Kerry, Tralee, Ireland marymcc5000@gmail.com.

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|November 28, 2025
PubMed
Summary

A quality improvement project reduced inappropriate emergency department transfers from residential care facilities (RCFs) by implementing palliative care services. This initiative improved resident care and reduced healthcare costs.

Keywords:
Emergency departmentGeriatricsNursing homesPalliative CareQuality improvement

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Area of Science:

  • Geriatric Medicine
  • Palliative Care
  • Healthcare Quality Improvement

Background:

  • Rising life expectancy and social isolation increase residential care facility (RCF) populations.
  • High rates of inappropriate emergency department (ED) admissions from RCFs strain healthcare resources.
  • Inappropriate admissions are defined as transfers where lower-cost settings suffice.

Purpose of the Study:

  • To reduce inappropriate emergency department (ED) referrals from residential care facilities (RCFs) to University Hospital Kerry (UHK).
  • The specific aim was to decrease inappropriate referrals from 50% to 30% within a defined timeframe (March 2024 - May 2025).

Main Methods:

  • Implemented a quality improvement project (QIP) with a SMART aim.
  • Introduced standardized terminology via a palliative frailty multidisciplinary team.
  • Developed a communication document for resuscitation status and treatment escalation.
  • Launched an advanced nurse practitioner (ANP) palliative care service for RCFs, supported by a palliative medicine physician.
  • Integrated education for RCF staff.

Main Results:

  • Reduced monthly ED attendances of RCF residents from a median of 82 to 50.
  • Decreased the rate of inappropriate attendances from 50% to 31%.
  • Received overwhelmingly positive stakeholder feedback.
  • Achieved financial savings for the health service.

Conclusions:

  • Integrated geriatric and palliative medicine services enhance RCF staff knowledge and care pathways.
  • Standardized terminology and alternative care models improve patient management.
  • A dedicated ANP palliative care service ensures residents receive appropriate care in the right setting.