Research Proposal
I am currently in my second course of my Master's Degree (MHST 603- Facilitating Inquiry), and as our first assignment we have been asked to come up with a research proposal. Professionally I have been working as a Registered Nurse (RN) in critical care for many years and have limited experience in the field of research, so this topic was a bit daunting initially. After further reflection, I decided to focus on my area of passion which is our senior population. My research proposal (outlined below), focuses on the prevalence information gaps that occur during transfers from long-term care (LTC) facilities via EMS to the hospital emergency department (ED) and the effect on patient outcomes. I will be further examining whether implementing a universal standardized communication tool will help narrow these information gaps, and allow health care workers to provide better care to our seniors.
Research Problem
There are many challenges associated during care transitions of the elderly due to their complex health care needs. Seniors often have multiple co-morbidities, several health care providers, and suffer from cognitive impairment, which limits their ability to participate in their care (Kessler & Williams, 2013). Senior transfers from nursing homes to the emergency department usually occur in urgent or emergent circumstances which do not permit adequate time on coordinating care transitions. Studies have shown there is often vital information missing during these patient transfers (Griffiths & Morphet, 2014). Communication gaps can cause serious breakdowns in continuity of care, inappropriate treatment, unnecessary re-hospitalizations, and the potential for adverse events (Kessler & Williams, 2013).
Concepts Being Studied
Differing styles of communication can lead to a lack of understanding and frustration among health care professionals. There is a need for a common language when communicating critical information. The use of a universal standardized transfer tool for improving patient handoffs allows the transfer of essential health information in a concise format (World Health Organization, 2007).
Theory
Standardized communication tools have been evaluated as a solution to omissions in critical health information and may be helpful in reducing the risk of medical errors, improving inter-professional collaboration, and quality of care (Kessler & Williams, 2013).
Discussion
Use of the emergency department by elderly patients
Prevalence of information gaps during transfers from nursing homes to the emergency department
Communication during clinical handover
Consequences of ineffective communication and patient outcomes
Challenges with care transitions
Standardized communication tools
Addressing barriers
Search Strategy
Searches were conducted using the databases PubMed, Google Scholar, MEDLINE, CINAHL, and Athabasca University library, as well as other websites including Registered Nurses Association of Ontario (RNAO), Canadian Nurses Association (CNA), World Health Organization (WHO) and Geri-EM.
The search strategy was narrowed to specifically examine communication gaps during patient transfers of seniors from long-term care facilities via EMS to the hospital emergency department. To date I have found fifteen articles relevant to this particular topic.
Search Words
seniors, long-term care facilities, emergency department, standardized communication tool, transitions of care, geriatric handover, patient safety, quality of care, EMS, patient transfer, information gaps, poor communication.
Thesis Statement
Implementing a universal standardized communication tool for transfers from long-term care facilities via EMS to the hospital emergency department will improve communication gaps of pertinent health information between nursing facilities and ED's, reduce risk of medical error, improve patient safety and quality of care.
References
Kessler, C., Williams, M.C., Moustoukas, J.N., Pappas, C. (2013). Transitions of Care for the Geriatric Patient in the Emergency Department. Clinic Geriatric Medicine, (29)49-69. Retrieved from https://geri-em.com/wp-content/uploads/2013/05/ClinGeriatrMed_Transitions-3.pdf
Griffiths, D., Morphet, J., Innes, K., Crawford, K., Williams, A. (2014). Communication between residential aged care facilities and the emergency department: A review of the literature. International Journal of Nursing Studies, (51) 1517-1523. Retrieved from https://www.journalofnursingstudies.com/article/S0020-7489(14)00159-X/pdf
World Health Organization (WHO). (2007). Communication During Patient Hand-Overs. Patient Safety Solutions. Retrieved from http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf
Pearson, K.B. & Coburn, A.F. (2013). Emergency transfers of the elderly from nursing facilities to critical access hospitals: Opportunities for improving patient safety and quality. (Policy Brief #32). Maine Rural Health Research Center (MRHRC). Flex Monitoring Team. Retrieved from http://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1001&context=lo