• Joseph G Ouslander, Gerri Lamb, Mary Perloe, JoVonn H Givens, Linda Kluge, Tracy Rutland, Adam Atherly, and Debra Saliba.
• Charles E. Schmidt College of Biomedical Sciences and Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA. joseph.ouslander@fau.edu
• J Am Geriatr Soc. 2010 Apr 1;58(4):627-35.

ObjectivesTo examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents.DesignMedical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization.SettingNHs in Georgia.ParticipantsIn 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long- and short-stay residents.MeasurementsRatings using a structured review by expert NH clinicians.ResultsOf the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations.ConclusionIn this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.

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