Minor trauma in nursing home residents – Identifying facilitators and barriers of telemedical surgical assessments in geriatric patients to reduce nursing-home sensitive conditions (NHSCs). Data and experiences from the Optimal@NRW study

Introduction: Recently an increasing number of older adults leads to so-called nursing-home-sensitive conditions (NHSCs): nursing home residents (NHR) are often transported to hospitals with diseases that could have been treated outpatient [1]. NHSCs are associated with health-related complications[1,2]. We hypothesized that telemedicine is an option in minor trauma cases and could be a new delivery model to reduce NHSC.

Material&Methods: In a cluster-randomized trial 24 nursing homes in Aachen (Germany) were supplied with a 24/7 telemedical consultation service, including real-time vital data, stethoscope and mobile non-physician assistants to perform delegable actions. A retrospective analysis examined the minor trauma cases to conclude on facilitators and barriers of telemedical surgical assessment.

Results: From 338 teleconsultations, 29 cases complied with the definition of minor trauma. 82% were acute falls or consequences of falls (focus on head and upper extremity injuries).The caregiver performed a physical examination under the telephysician's supervision in all cases. In 72.4%, vital data were raised. In 10%, a mobile assistant was sent out for delegable actions. In 13.7%, there was a need for transport to the emergency room (head trauma in combination with oral anticoagulation or for fracture exclusion).

Conclusion: 86.3% of minor trauma cases were treated ambulatory. Physical examination can be a delegable action facilitated by video supervision. Barriers were trauma in patients with oral anticoagulation or those who required X-ray or CT scan.

[1]Valk-Draad,M.P. et al.,Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen. Bundesgesundheitsblatt, 2023.66(2),p.199–211.

[2]Kurte,M.S. and K.Blankart(2019).Ambulant-sensitive Krankenhausfälle in Deutschland– Abgrenzung, Prävalenz und Kosten.Gesundheitsökonomie & Qualitätsmanagement 24(06): 277-291.

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