Perceptions and experiences of residents and relatives of emergencies in care homes: systematic review and meta-synthesis?

The problem Medical emergencies in care homes, both residential and nursing care homes, are common and costly, often resulting in calls to an out-of-hours general practitioner or Emergency Medical Services. Ambulance attendance frequently results in conveyance to hospital with concomitant high costs and risks of, often prolonged, hospitalisation. Previous studies and systematic reviews on emergencies in care homes have focussed mainly on rates and reasons for transfer to hospital, with less consideration for the wider context. To ensure high quality emergency care that is effective, efficient, safe, providing a good experience for service users, we need to understand more broadly the experience of emergency care provided within care homes from the perspectives of residents and their relatives.The aim of this systematic review was to provide a comprehensive synthesis of the perceptions and experiences of care home residents and their family members, who have experienced medical emergencies in a care home setting. The approach We searched five electronic databases, supplemented with internet searches and forward and backward citation tracking from included studies and reviews. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the studies included.Findings The search strategy identified 6,140 citations. After removing duplicates and excluding citations based on title, abstract, and full-text screening, ten studies from four countries (Australia, Canada, UK, US) were included in the review and meta-synthesis. All included studies were considered of acceptable quality. Through an iterative approach, we developed six analytical themes. 1. Infrastructure and process requirements in care homes to prevent and address emergencies (describes the experience and perceptions of care home care from the perspective of residents and relatives); 2. The decision to transfer to hospital (describes the experience and perceptions of transfer decisions); 3. Challenges of transfer and hospitalisation for older patients (describes negative and positive experiences of care home residents and relatives and perceptions of emergency department, hospital care and return to the care home); 4. Good communication vital for desirable outcomes (describes the importance of information sharing and communication between residents, relatives and healthcare staff for good health outcomes and experiences); 5. Legal, regulatory and ethical concerns (describes the legal status of family members, regulatory responsibilities of staff and ethical concerns including advance care planning and end-of-life decisions); and 6. Trusting relationships enabled residents to feel safe (describes the importance of positive ongoing relationships with staff and trust in care workers for safe urgent care).Implications The emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care. Building trusting relationships underpinned by good communication and attention to ethical practice were also identified as important factors.

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