ArticleJournal of the American Geriatrics Society2017
Do-Not-Hospitalize Orders in Nursing Homes: "Call the Family Instead of Calling the Ambulance".
Article in Journal of the American Geriatrics Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Hospitalizations of nursing home residents at the end of life: A systematic review.Palliative medicine · 2019Pooled it
- Experiences and involvement of family members in transfer decisions from nursing home to hospital: a systematic review of qualitative research.BMC geriatrics · 2019Pooled it
- Appropriateness of transferring nursing home residents to emergency departments: a systematic review.BMC geriatrics · 2019Pooled it
- Effect of advance care planning video on do-not-hospitalize orders for nursing home residents with advanced illness.BMC geriatrics · 2022Trial
- Concordance between Goals of Care and Treatment Decisions for Persons with Dementia.Journal of palliative medicine · 2018Trial
- Diagnoses Associated With Hospitalization of Nursing Home Residents With Severe Functional Impairment and Terminal Illness.Journal of the American Medical Directors Association · 2025Article
- 'Weighing up risks': a model of care home staff decision-making about potential resident hospital transfers.Age and ageing · 2022Article
- Outcomes of advance care directives after admission to a long-term care home: DNR the DNH?BMC geriatrics · 2022Article
- Using advance and emergency care plans during transfer decisions: A grounded theory interview study with care home staff.Palliative medicine · 2022Article
- The Avoidable Transfer Scale: A New Tool for Identifying Potentially Avoidable Hospital Transfers of Nursing Home Residents.Innovation in aging · 2022Article
- Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study.Aging clinical and experimental research · 2021Article
- Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia.Journal of the American Medical Directors Association · 2020Article
- Paramedics' Perspectives on the Hospital Transfers of Nursing Home Residents-A Qualitative Focus Group Study.International journal of environmental research and public health · 2020Article
- Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies.BMC family practice · 2020Article
- Nursing home staff's perspective on end-of-life care of German nursing home residents: a cross-sectional survey.BMC palliative care · 2020Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectivesTo determine how do-not-hospitalize (DNH) orders are interpreted and used in nursing homes (NHs) once they are in place.
designQualitative study using in-depth semi-structured interviews performed from December 2013 to April 2014.
settingEight skilled nursing facilities in Connecticut that ranked in the top 10% or bottom 10% in hospitalization rates from 2008 to 2010.
participantsNursing facility staff members (N = 31). MEASUREMENTS: A multidisciplinary team performed qualitative content analysis. The constant comparative method was used to develop a coding structure and identify themes.
resultsDNH orders were uncommon at low- and high-hospitalizing facilities. Participants reported that they did not interpret these orders literally. A DNH order was not a prohibition against hospitalization but was understood to have a variety of exceptions. These orders functioned primarily as a signal that hospitalization should be questioned and discussed with the family when an acute event occurred.
conclusionIn-the-moment discussions about hospitalization are still necessary even when a DNH order is in place. Work to reduce potentially burdensome NH-hospital transfers needs to focus not just on eliciting preferences in advance, but also on preparing residents and their families to make the best decisions about hospitalization when the time comes.
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