[Emergency situations and emergency department visits in nursing homes-a scoping review about circumstances and healthcare interventions]. / Notfallsituationen und Krankenhauszuweisungen in Pflegeeinrichtungen ­ ein Scoping-Review zu Begleitumständen und versorgungsrelevanten Maßnahmen.

BACKGROUND: Nursing home residents are more likely to be hospitalized as non-institutionalized peers. A large number of emergency medical services (EMS) and emergency department visits are classified as potentially avoidable. OBJECTIVES: To identify circumstances that increase the number of emergency situations in nursing homes and approaches to reduce hospital admissions in order to illustrate the complexity and opportunities for action. MATERIALS AND METHODS: Scoping review with analysis of current original and peer-reviewed papers (2015-2020) in PubMed, CINAHL, and hand-search databases. RESULTS: From 2486 identified studies, 302 studies were included. Injuries, fractures, cardiovascular, respiratory, and infectious diseases are the most frequent diagnostic groups that have been retrospectively recorded. Different aspects could be identified as circumstances inducing emergency department visits: resident-related (e.g., multimorbidity, lack of volition, and advance directives), facility-related (e.g., staff turnover, uncertainties), physician-related (lack of accessibility, challenging access to specialists), and system-related circumstances (e.g., limited possibilities for diagnostics and treatment in facilities). Multiple approaches to reduce emergency department visits are being explored. CONCLUSIONS: A variety of circumstances influence the course of action in emergency situations in nursing facilities. Therefore, interventions to reduce emergency department visits address, among other things, strengthening the competence of nursing staff, interprofessional communication, and systemic approaches. A comprehensive understanding of the complex processes of care is essential for developing and implementing effective interventions.

" darum rufe ich jetzt den Rettungsdienst!"

"… that's why I call the ambulance!" - A qualitative study of emergency scenarios in nursing homes Abstract. Background: In nursing homes, emergencies lead to frequent utilisation of emergency medical services (EMS) and emergency department visits. A broad interprofessional perspective of involved practitioners on emergencies in nursing homes has been little studied so far. Aim: Characterization, identification and prioritization of emergency scenarios by relevance and frequency in nursing homes. Methods: We conducted two multi-method, interprofessional group discussions with a total of 18 participants from nursing, medicine and science in January and February 2020. Group discussions were recorded, transcribed and analyzed using qualitative content analysis according to Mayring. Results: Emergency scenarios in nursing homes arise from interactions between person-related aspects and contextual conditions. The following person-related aspects were named as relevant: Falls, unstable vital signs, abnormal behavior, neurological symptoms and lifelessness. Contextual conditions are classified into organizational-structural, political-legal and ethical aspects. The following were considered to be most relevant: lack of communication between the actors, uncertainties among staff, absent living wills and increasing workload in nursing. Conclusions: Emergencies in nursing homes turn out to be complex emergency scenarios. Contextual conditions are important for dealing with emergency scenarios in nursing homes. Recommended actions should be based on the perspective of involved practitioners on emergencies and take greater account of the contextual conditions.