A toolkit for clinicians rounding in long-term care facilities.

Residents living in long-term care (LTC) facilities are some of the most complex patients clinicians will encounter. Rounding on these patients can be made additionally challenging by a lack of appropriate bedside equipment, which can limit clinicians’ abilities to perform thorough evaluations. Because of this problem, clinicians may recommend transport to a clinic for further diagnosis and treatment, or they may forgo a thorough diagnostic evaluation. We investigated a third option – bringing a set of diagnostic and procedural equipment on bedside rounds to LTC facilities – with the goal of decreasing fragmentation of care due to equipment difficulties and thus improving quality of care. We did not identify a currently existing toolkit, and a literature search yielded minimal results. We started by developing a list of the procedures we considered feasible to perform during LTC rounds. We also identified the tools we thought were necessary to conduct a thorough bedside physical examination and any of the procedures we considered. We then surveyed clinicians attending three geriatric and primary care CME meetings about equipment currently available to them and what additional equipment they would need to provide comprehensive care. Of the 94 responding clinicians, 47 percent were nongeriatrician physicians, 15 percent were geriatrician physicians, 32 percent were nurse practitioners, 3 percent were physician assistants, and 6 percent were other clinicians. (Percentages do not equal 100 because three clinicians indicated multiple credentials.) Nearly 90 percent of the clinicians had practiced five years or more. Overall, we found a wide variety in the use of equipment in LTC facilities. Otoscopes and flashlights were the most commonly used equipment (77 percent of respondents). Dermatoscopes and anoscopes were least used (less than 10 percent of respondents). Clinicians reported they would use both disposable and durable equipment more frequently if it were available at the bedside. One of the durable items with the largest anticipated use was the ultrasound Doppler. Seventeen percent of respondents indicated they currently use a Doppler, and 59 percent of respondents indicated they would use a Doppler if one was readily accessible. Of the disposable items, a sterile razor blade for shave biopsies was one of the items with the greatest increase in anticipated use. Twenty-six percent of respondents indicated they currently use sterile razor blades, and 66 percent indicated they would use sterile razor blades if they