Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy

Manckoundia, Patrick; Menu, Didier; Turcu, Alin; Honnart, D.; Rossignol, Sylvie; Alixant, Jean-Christophe; Sylvestre, Franck-Henry; Bailly, Vanessa; Dion, Michèle; Putot, Alain

doi:10.1016/j.jamda.2016.04.017

Cited by 18 publications

(31 citation statements)

References 20 publications

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“…Although the total number of patients with rheumatic comorbidities -a condition that might be prone to subacute problem -was very low (n = 7), it can be assumed that diseases of complex organs generally more often require hospitalizations or invasive interventions than connective tissue diseases, and are, therefore, more often necessary. These ndings re ect the results from previous investigations, where common reasons for inappropriate visits are described as non-emergent symptoms or condition manageable by a general practitioner (24,28). On the other hand, the fact that the visit was appropriate does not mean, it was not avoidable: the early detection and treatment of deteriorating symptoms, especially with diagnoses like congestive heart failure, helps prevent exacerbations and avoid ED visits for acute situations no longer controllable in the nursing home.…”

Section: Predictors Of Inappropriate Ed Visitssupporting

confidence: 78%

“…Within the analyzed sample, 6.0% of LTC-facility referrals were assessed as inappropriate. This is relatively low, when compared to 4-55% found in a recent systematic review (14), including studies from Europe, the US, Australia, and Asia (12,13,24). Still, admission rates and, alongside, inappropriate EDvisits are rising in Switzerland as well (25).…”

Section: Predictors Of Inappropriate Ed Visitsmentioning

confidence: 83%

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Inappropriate emergency admissions from nursing homes in Switzerland: a retrospective chart review

Gaertner

Schuh

Löw

et al. 2020

Preprint

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Background increasing numbers of multimorbid patients living in long-term care (LTC) residential facilities are challenging ambulant care. In times of overcrowded emergency departments (ED), inappropriate ED visits need to be avoided to ensure optimal health care. This study aimed to determine and characterize inappropriate ED consultations of LTC residents including ED resource consumption. Methods this retrospective chart review was conducted at the ED of a Swiss tertiary hospital with a catchment area of about two million people. The analysis included 1’276 LTC-residents referred to the study centre between January 2015 and December 2017. Patient and consultation characteristics (age, gender, Charlson Comorbidity Index, as well as type and time of admission, length of stay in the ED, presence or absence of a consecutive hospitalization, and data on ED resource consumption) were extracted from the ED’s documentation system. Appropriateness was assessed using an established evaluation protocol. All variables were described in absolute numbers, percentages or median and interquartile range (IQR). Associations with inappropriateness status were tested with chi-square or Wilcoxon rank sum test respectively. A multivariable logistic regression analysis was preformed to identify predictors of inappropriate ED visits. Results The referred LTC-residents had a median age of 84 (IQR 78–89) years; 77 referrals (6.0%) were assessed as inappropriate. The final model revealed increased odds for an inappropriate admission for a less acute triage class and patients with connective tissue disease (both p ≤ 0.001), but lower odds for night-time admissions (p = 0.035) and the presence of cerebrovascular diseases (p = 0.043), respectively. The ED resource consumption differed significantly between appropriate and inappropriate visits (p ≤ 0.001). Conclusion Inappropriate admissions from nursing homes were low and less resource intensive than appropriate admissions. Preventive strategies focusing on high-quality ambulatory day-care might further reduce inappropriate emergency admissions.

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Section: Predictors Of Inappropriate Ed Visitssupporting

confidence: 78%

Section: Predictors Of Inappropriate Ed Visitsmentioning

confidence: 83%

Inappropriate emergency admissions from nursing homes in Switzerland: a retrospective chart review

Gaertner

Schuh

Löw

et al. 2020

Preprint

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“…The definition of inappropriateness varied widely between studies (see Additional file 2: Table S3). Some authors defined inappropriate ED transfers as preventable transfers; a transfer that may have been avoided if an existing condition would have been managed optimally in the NH at an earlier stage or when adequate prevention would have avoided its initial presentation [2, 27, 29, 45, 47]. Other authors defined inappropriateness by using a list of symptoms and conditions that were frequently associated with potentially preventable ED visits and hospitalisations [18, 27, 29, 31, 33, 44–46, 48].…”

Section: Resultsmentioning

confidence: 99%

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

et al. 2019

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BackgroundElderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.MethodsSystematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract.ResultsSeventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital.ConclusionsThe definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.

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“…Inappropriate admissions occur worldwide and pose a challenge to health policy and management, although the underlying causes and determinants differ between countries. For technical reasons, oversight of the appropriateness of admission is relatively difficult [ 8 , 9 , 10 ]. Multiple studies have focused on assessing inappropriate admissions using expert evaluation methods [ 11 ], the opinion of the assessment team or rapid-response team [ 12 ], an intensity–severity–discharge review system with adult criteria [ 13 , 14 ], or an appropriateness evaluation protocol (AEP) [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Inappropriate Admissions in County Hospitals in Rural China: A Cross-Sectional Study

Zhang

et al. 2018

IJERPH

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Inappropriate admissions have contributed to the rapid increase in hospitalisations in rural China. This study characterised the degree and determinants of inappropriate admissions in county hospitals. We used expert consultation to develop an appropriateness evaluation protocol that included nine requirements for services and 21 indicators of disease severity. A total of 2230 medical records from 2014 were collected from five county hospitals by stratified cluster sampling and evaluated for appropriateness using the protocol in 2016. The determinants of inappropriate admissions were analysed by two-level logistic regression. The overall inappropriate admission rate was 15.2%. Patients aged <20 years (19.3%), patients in the paediatrics department (22.9%), patients with lower disease severity (22.3%), and patients without complications (17.0%) were more likely to have been inappropriately admitted than other groups. Age, treating department, disease severity, causes of hospitalisation, complications, and length of stay were determinants of inappropriate admission. Policymakers must act to reduce the high prevalence of inappropriate admissions in county hospitals in rural China, by guiding patients to seek primary care and changing the motivating mechanism of these hospitals.

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Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy

Cited by 18 publications

References 20 publications

Inappropriate emergency admissions from nursing homes in Switzerland: a retrospective chart review

Inappropriate emergency admissions from nursing homes in Switzerland: a retrospective chart review

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

Determinants of Inappropriate Admissions in County Hospitals in Rural China: A Cross-Sectional Study

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