Automated Transfer Form May Improve Emergency Care for Nursing Home Residents

A prototype of a standards-based automated transfer form was designed to help improve the care of nursing home residents transferred to emergency departments by providing more complete information upon arrival. Creators described the prototype’s development in AMIA Annual Symposium Proceedings. 

“Nursing home patients are extensive users of emergency department services,” wrote first author Joshua R. Vest, PhD, MPH, of the Indiana University Richard M. Fairbanks School of Public Health and coauthors. “Problematically, poor information sharing and incomplete access to information complicates the delivery of care in emergency department for nursing home patients.” 

Dr Vest and colleagues created their Substitutable Medical Applications and Reusable Technologies Fast Health Interoperability Resources automated transfer form, or SMART on FHIR for short, after interviewing emergency department providers, reviewing existing paper-based forms, surveying end users, and holding a workshop with clinical and information representatives to guide the form’s design. 

The information gathering revealed five elements deemed most useful for inclusion on the transform form: emergency contact/health care proxy, current medication list, reason for emergency department transfer, baseline neurological state, and relevant diagnoses/medical history. 

“I don't really care if they had their wisdom teeth out when they were 16 and they're 90, but just key problems that are important: coronary heart disease, hypertension, diabetes…,” clarified one interviewee quoted in the paper.  

Participants in the design workshop stated a preference for a single-page, top-down form, researchers reported. They preferred different colors for headers and information, as well as boxing or grouping key information in one spot. An overall preference was for the top of the form to list both the reason for the patient’s transfer to the emergency department and information, such as advance directives, essential for immediate clinical decisions. 

The next phase is to pilot the automated transform form in an actual emergency department. 

“The emergency department is a frequent site of care for nursing home patients, but care in this setting is fraught with communication challenges,” researchers wrote. “The expansion of interoperable health information and standards may be leveraged to address the limitations of paper-based information sharing.” 

—Jolynn Tumolo

Reference:

Vest JR, Unruh MA, Hilts KE, et al. End user information needs for a SMART on FHIR-based automated transfer form to support the care of nursing home patients during emergency department visits. AMIA Annu Symp Proc. 2021;2020:1239-1248. Published 2021 Jan 25.