Background Care home residents are more likely to attend and be admitted to hospital in unplanned, emergency situations than age-matched people living in their own homes, yet some transfers and admissions can be burdensome, leading to declines in health and well-being. Existing research has acknowledged the importance of understanding the local context in which transfers occur, yet research conducted in England is lacking. Methods To develop an in-depth understanding of care home staff transfer decisions in England, data collection occurred in two phases. Firstly, semi-structured interviews were carried out with 30 care home staff across six care homes in the East and West Midlands. Secondly, 113 hours of ethnographic work (consisting of observations, documentary analysis and informal conversations) occurred across three of the six homes. Data gathered in both phases were analysed together using the Straussian approach to grounded theory. Results Staff preferred to care for residents in the care home where possible. Transfers often occurred following a series of escalations in which staff sought to balance a number of risks. Staff primarily understood risk by drawing on their experiential knowledge of what was usual for each resident, yet also drew upon advance care plans and observations of early warning signs. Staff sought to manage risks by involving others in decision-making (colleagues, residents, relatives, healthcare professionals), yet this required staff to anticipate and mitigate potential disagreements. Conclusions This study highlights a substantial amount of work care home staff undertake prior to calling external services and offers a novel approach to understanding hospital transfers from care homes, by foregrounding the different forms of risk staff feel responsible for balancing. Further research is needed to assess the ways new and existing interventions enable care home staff to manage risk during transfer decisions. The implications for emergency care services will be discussed.

中文翻译：

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01 “在艰难险阻之间”：养老院工作人员对在居民转移决策期间平衡风险的看法

背景 与住在自己家中的年龄匹配的人相比，护理院的居民更有可能在计划外的紧急情况下就诊和入院，但一些转移和入院可能是繁重的，导致健康和福祉下降。现有研究已经承认了解转移发生的当地环境的重要性，但缺乏在英格兰进行的研究。方法 为了深入了解英格兰养老院员工的调动决定，数据收集分两个阶段进行。首先，对东米德兰兹和西米德兰兹的 6 个疗养院的 30 名疗养院工作人员进行了半结构化访谈。其次，六个家庭中的三个进行了 113 小时的民族志工作（包括观察、文献分析和非正式对话）。使用 Straussian 方法对扎根理论进行了分析，同时对这两个阶段收集的数据进行了分析。结果 工作人员更愿意在可能的情况下照顾疗养院的居民。转移往往发生在一系列升级之后，工作人员在这些升级中试图平衡一些风险。工作人员主要通过利用他们对每位居民通常情况的经验知识来了解风险，同时也利用预先护理计划和对早期预警信号的观察。工作人员试图通过让其他人（同事、居民、亲属、医疗保健专业人员）参与决策来管理风险，但这要求工作人员预测和减少潜在的分歧。结论 本研究强调了护理院工作人员在致电外部服务之前所承担的大量工作，并提供了一种新的方法来了解从护理院转院的医院，方法是突出员工认为有责任平衡的不同形式的风险。需要进一步研究来评估新的和现有的干预措施如何使疗养院工作人员在转移决策期间管理风险。将讨论对紧急护理服务的影响。