Models of care that avoid or improve transitions to hospital services for residential aged care facility residents

an integrative review

L. Testa*, R. Seah, K. Ludlow, J. Braithwaite, R. J. Mitchell

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)


Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care. As standalone interventions, standardised communication tools may improve information transfer between RACFs and hospital services. For more complex models, providing quality improvement and outreach to RACFs may prevent some types of hospital admissions.
Original languageEnglish
JournalGeriatric Nursing
Publication statusAccepted/In press - 12 Mar 2019



  • Aged care
  • Care transition
  • Hospitalization

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