Our Urgent and Emergency Care Theme completed a synthesis of existing qualitative reviews to explore how decisions to transfer residents from care homes to the Emergency Department are made. The synthesis encompassed the experiences of residents, family members and care home staff. Six previous systematic reviews and two full study reports were included.
We found three important common themes. Transfer decisions are complex and involve power dynamics between residents, family members, care home staff and health care professionals. Reassuringly, some transfers are necessary and are made with the positive intent of improving resident outcomes with conditions like broken bones thought to always need treatment in hospital. However, some decisions are made with no expectation of improving resident outcome and are due to factors unrelated to clinical need such as concerns of medico-legal repercussions and lack of advanced care planning
