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Background <p>As the population ages, the medical needs of residents in long-term care (LTC) facilities are increasing. However, there remains a lack of in-depth exploration of how clinical information and care responsibilities are understood and transferred across settings when LTC residents are transferred to emergency departments (EDs). Guided by a cross-setting perspective, this study aimed to explore the care transition experience during transfers of LTC facility residents to the ED, focusing on the use of medical information and shifts in care responsibilities.</p> Methods <p>A qualitative research design was adopted. Semi-structured in-depth interviews were conducted with nine LTC facility nurses and seven ED clinicians (five nurses and two physicians) in northern Taiwan. Data were analyzed using thematic analysis.</p> Results <p>Three themes were identified: (1) assessment and preparation at LTC facilities for ED transfers; (2) information and communication discontinuities during cross-setting care transitions; and (3) information reconstruction and assumption of care responsibilities in the ED. The written and verbal handoff information provided by LTC facilities was not always directly translatable into a basis for clinical judgment upon the residents’ arrival in the ED. This challenge arose not simply from information gaps, but from differences in the clinical meaning and intended use of information across care settings, requiring ED staff to reinterpret and reconstruct the residents’ clinical context under time pressure. Furthermore, when the accompanying caregiver’s handoff capacity was limited and medical decision-makers were unable to participate in real time, the ED assumed not only acute medical treatment, but also medical decision-making and daily care responsibilities originally held by the facility and family members.</p> Conclusions <p>The cross-setting care transition of LTC facility residents to the ED is a dynamic process of information reinterpretation and responsibility redistribution. Future transfer mechanisms should address the complex medical histories and care-oriented characteristics of facility residents and establish information-sharing systems with clearly defined responsibility boundaries to promote continuity of care.</p>

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The experience of cross-setting care transitions of long-term care residents to the emergency department: a qualitative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Pin-Chieh Hsu,
  • Lu-Yen Anny Chen,
  • Yu-Chi Chen,
  • Tzu-Ying Chang,
  • Man-Hua Yang

摘要

Background

As the population ages, the medical needs of residents in long-term care (LTC) facilities are increasing. However, there remains a lack of in-depth exploration of how clinical information and care responsibilities are understood and transferred across settings when LTC residents are transferred to emergency departments (EDs). Guided by a cross-setting perspective, this study aimed to explore the care transition experience during transfers of LTC facility residents to the ED, focusing on the use of medical information and shifts in care responsibilities.

Methods

A qualitative research design was adopted. Semi-structured in-depth interviews were conducted with nine LTC facility nurses and seven ED clinicians (five nurses and two physicians) in northern Taiwan. Data were analyzed using thematic analysis.

Results

Three themes were identified: (1) assessment and preparation at LTC facilities for ED transfers; (2) information and communication discontinuities during cross-setting care transitions; and (3) information reconstruction and assumption of care responsibilities in the ED. The written and verbal handoff information provided by LTC facilities was not always directly translatable into a basis for clinical judgment upon the residents’ arrival in the ED. This challenge arose not simply from information gaps, but from differences in the clinical meaning and intended use of information across care settings, requiring ED staff to reinterpret and reconstruct the residents’ clinical context under time pressure. Furthermore, when the accompanying caregiver’s handoff capacity was limited and medical decision-makers were unable to participate in real time, the ED assumed not only acute medical treatment, but also medical decision-making and daily care responsibilities originally held by the facility and family members.

Conclusions

The cross-setting care transition of LTC facility residents to the ED is a dynamic process of information reinterpretation and responsibility redistribution. Future transfer mechanisms should address the complex medical histories and care-oriented characteristics of facility residents and establish information-sharing systems with clearly defined responsibility boundaries to promote continuity of care.