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Nursing home hospital transfers in the terminally ill: night shift nurses matter!
  1. Guillaume Economos1,
  2. Francoise Tholly2,
  3. Wadih Rhondali1,
  4. Murielle Ruer1,
  5. Colombe Tricou1,
  6. Audrey Fawoubo1,
  7. Élise Perceau-Chambard1 and
  8. Marilene Filbet1
  1. 1 Palliative Care, Hospices Civils de Lyon, Lyon, France
  2. 2 Agence Regionale de Sante Auvergne-Rhone-Alpes, Lyon, France
  1. Correspondence to Professor Marilene Filbet, Palliative Care, Hospices Civils de Lyon, Lyon 69495, France; marilene.filbet{at}chu-lyon.fr

Abstract

Background French demographic projection expects an increasing number of older, dependent patients in the next few years. A large proportion of this population lives in nursing homes and their transfer to hospitals at the end of life is an ongoing issue.

Objective This study explored the factors influencing the transfer of patients living in nursing homes to hospital at the end of life.

Design We used a mixed-methods questionnaire developed by an expert group and assessing different characteristics of the nursing homes.

Participants All the nursing homes in the Rhône-Alpes area (n=680) were surveyed.

Results We obtained 466 (68%) answers. We found that a palliative care programme was present in 336 (72%) nursing homes. The majority had a coordinating physician 428 (82%) and a mean number of 6 nurses for 83 beds, with 83 (18%) having a night shift nurse. There was a mean number of 19 deaths per nursing home during the recorded year. The main cause of death was dementia (41%), cancer-related death (13%). Death occurred mostly in the nursing home (14 74%). Night shift nurse attendance was significantly associated with the place of death: 27 deaths occurred in nursing homes with a night shift nurse versus 12 in those without one (p<0001).

Conclusions The location of the death of frail elderly patients is a major health issue that needs to be addressed. Our results suggests that the presence of a night shift nurse decreases the number of emergency transfers and deaths in the hospital.

  • Hospice care
  • Nursing Home care
  • End of life care
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Footnotes

  • Contributors GE analysed the dataset and wrote the manuscript. FT participated in designing the study and implementing it. WR participated in designing the study and implementing it. MR acquired the data. CT analysed the dataset. AF participated in the data interpretation, drafting the manuscript and reviewing it. EP-C participated in designing the study and supervising it. MF participated in designing the study and supervising it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional ethics committee of the Hospices Civils de Lyon reviewed and approved the protocol of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request (in French language for the qualitative part).

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