McDonald, T. A., 2009
IAAG Conference, Paris France
Background: Following several years of receiving complaints about unsafe hospital clinical practices and risky management of older patients, the peak representative body for aged care services commissioned a survey of their members to determine if the issues being complained about were happening elsewhere across the hospital and aged care interface.
Objective: The aim was to determine long-term care providers’ views on whether hospitals meet standards set in national statements on best practice for hospital care of older people
Methods: A national survey based on complaints received was distributed to all member organisations of the peak aged care services body. Some questions were about their service and others were open ended for optional comments about the on safety and quality issues related to dealings with local hospitals providing acute health services to residents. In all, 371 responses were returned from across Australia and including metropolitan and regional areas (Estimated response rate 55%). The data were analysed descriptively using SPSS and thematic analysis of optional comments.
Results: Quantitative Problem areas identified by health professionals external to hospitals confirmed that the matters complained about prior to the survey were occurring across the sector. These included: Timing of patient transfers from hospitals (70.89%); Coordination problems (51.21%);Information on patient’s condition (72.51%); Appropriate hospital management of mental confusion (41.42%); Nutritional status of patients on discharge (28.30%); Skin integrity status of patients on discharge (66.04%); Adequate documentation of clinical treatment in hospital (78.17%); Information provided by hospital clinicians to families (50.67%); Medication regime prescribed prior to patient discharge (63.43%). Concurrent evaluation of hospital performance against national standards revealed an equally poor result.
Qualitative Accounts of clinical care in specific situations indicate a growing culture of dismissiveness by nursing and medical clinicians of the care and safety needs of older patients. Justifications used to respond to these examples of neglect include workload pressures and clinician judgements of older patients’ eligibility for hospital access. The larger the hospital the more likely these attitudes are observed by colleagues external to the hospital
Conclusions: Competence issues were found relating to organising transport, ensuring safety and comfort of older people during transport, provision of basic patient care while in hospital, management of medications for continuity of care, communication of health information between hospital clinicians and those in aged care homes and much more. More research is needed to investigate why or if older adults transferred from aged care are unique experiencers of this phenomenon or if the issues extend to other patient categories as well.
CITATION McDonald T. (2009) How competent are hospital clinicians perceived to be in managing the care of older people? 19th International Association of Geriatrics and Gerontology (IAAG) World Congress on Gerontology and Geriatrics “Social research, policy and practice” Paris, France. 5-9 July.
NOTE McDonald,T. (2007) For Their Sake: Can we improve the quality and safety of resident transfers from acute hospitals to residential aged care? The full report can be accessed at traceymcdonald.info/Content/resources/documents/For_their_sake_REPORT.pdf
For the executive summary: traceymcdonald.info/Content/resources/documents/for_their_sake__EXECUTIVE_SUMMARY_oct_07.pdf