Programme no. 252-P
Quality Improvement
Out of hours house calls to nursing home residents: do the visiting GPs get sufficient patient information?
Ingrid Rolfsjord*1, J√łund Straand2
1Oslo Outpatient Emergency Clinic,Oslo,Norway, 2Department of general practice,University of Oslo,Oslo,Norway
* = Presenting author
Objectives: To describe the quantity and quality of patient information provided during medical out of hours visits to NHRs. A particular focus was on information about decisions previously made for treatment intensity and how this corresponded with treatment initiated by the visiting physician.
Background: : In Oslo, out of hours medical emergency services for nursing home residents are provided by visiting general practitioners (GPs) from Oslo Emergency Outpatient Clinic (OEOC). Typically, nursing home residents (NHRs) are demented, frail, and multimorbid elderly with limited life expectancies and impaired ability to communicate. To make good medical decisions, a GP called for to see a NHR during nighttime therefore has to rely on information from other sources. However, the extent to which appropriate information from patient’s electronic medical record (EMR) or from nursing home staff are made available for out of hours visiting GPs is not known.
Results: Altogether 362 medical visits in nursing homes were recorded. Three out of four NHR visited were ≥ 80 years, one third ≥ 90 years, 70 % were diagnosed with moderate or severe dementia. In 53 % of the visits, the physicians were not provided access to the patient’s EMR. The probability for being presented the EMR was significantly lower for patients ≥80 years, and also if the nursing staff on duty had limited knowledge themselves about the patient in question.

In most cases (79 %), no information was available regarding whether or not cardiopulmonary resuscitation (CPR) should be undertaken.

Material/Methods: Prospective observational study. During three months we recorded all house calls to NHR made by OEOC physicians. A questionnaire was filled out by the visiting doctor during each visit. Issues included were availability and quality of EMR, the patient knowledge by the nursing staff on duty, the hospitalization rates and the intensities of treatment.
Conclusion: Patient information including the patients’ general physical and mental condition, CPR status, and which level of treatment intensity that is to be followed in case of acute illness, was not made available for the visiting doctor in more than half of the visits. There were no significant differences regarding hospitalization rates or treatment intensities between patients with and without available medical information provided by the nursing staff or the EMR.
Points for discussion: Availability of EMRs for NHRs for visiting out of hours physicians?

Explicit decisions regarding treatment intensity (e.g. CPR) in severely demented NHRs with limited life expectancies – a need for quality improvement?