Apr 15, 2019

Delaying doctor’s ‘first visit’ in nursing homes could increase risk of dying

A delay in seeing a doctor, or not seeing a doctor at all, when a resident first moves into aged care may increase the likelihood the resident will be admitted to hospital, or even die, according to new research.

When a resident is first admitted to a nursing home, they generally undergo a range of assessments, including an assessment by a doctor.

In the first days of a resident’s time in care, it’s crucial the appropriate care regime is established from the start. The person’s likes and dislikes need to be established, their preferred routine noted, their medication schedule needs to be understood, and doctors and nursing home staff need to understand the new resident’s health issues.

Study: 10% have no first visit

New research has shed light on just how important this initial doctor’s assessment is.

The research by the University of Pennsylvania found that when older hospital patients were moved into a care situation, half were visited by a doctor within a day, and 80 per cent were visited within four days. However,  10 per cent weren’t visited at all.

The study found the patients who did not receive a visit from a doctor were nearly twice as likely to be readmitted to hospital than patients who did have an initial visit (28 per cent compared with 14 per cent).

Tragically, of those who didn’t receive an initial visit, twice as many died within 30 days of admission (14 per cent compared with 7 per cent).

First visits slower in regional centres and for the cognitively impaired

The study also found that initial assessments were generally later, or did not occur at all, in regional or rural setting.

Patients with a cognitive impairment also tended to be seen later, or not at all.

Though this study was conducted in the United States, it has implications for here in Australia. The study makes it clear that when residents are first moved into aged care, it is vitally important they are assessed, and that that assessment occurs within a relatively short time frame.

Particular care must be taken for aged care residents in small, regional and rural centres, where resources may be more difficult to come by.

And of course those with cognitive impairment should not be overlooked for assessment.

Improving care and health outcomes for aged care residents

This study makes it clear that the initial doctor’s consultant with a new nursing home resident is vitally important.

If ‘first visits’ always occur, and if they can be conducted in a timely way, not only might we be improving the care residents receive and their health outcomes, but we might also be extending their lives.

HelloCare sought a comment from the Aged Care Quality Commission and the Department of Health for this article, but at the time of publishing had not received a response.


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