Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents

Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review

“…Possible causes for such omissions include the lack of timely access to the patient’s treating physician [ 36 ] or a geriatric opinion [ 15 ], a failure to accurately assess the situation’s acuity, or simply the residents’ or their relatives’ preference to visit the ED. In a French study, Rolland et al corroborated this possibility, observing that residents with access to both specialist medical advice and a mobile emergency medical unit were less likely to experience potentially inappropriate ED transfers [ 12 ].…”

“…One suggested reason for high ED visit rates from nursing homes is a lack of advance care planning (ACP) [ 8 ]. Other reasons include lack of access to primary care services in the nursing home, insufficiently trained staff, as well as understaffing, lack of access to specialists’ medical advice and poor interprofessional collaboration [ 8 , 12 ]. Overall, depending on the definition and measurement method, 5% to 55% of ED visits are considered potentially inappropriate or avoidable [ 2 , 8 ].…”

“…Although this rating is not conclusive and a multi-layered approach is needed to assess each transfer individually, ACSCs provide a first impression of commonly avoidable reasons for ED visits. Only recently have studies begun to differentiate systematically between potentially inappropriate and potentially avoidable ED visits [ 12 , 13 ].…”

“…From an ED perspective, any visit for a non-emergency (somatic or psychiatric) situation, for which treatment could have been provided by a GP, or dealing with residents receiving palliative care or non-hospitalization orders in their files might be considered potentially inappropriate [12,14]. Such ED visits can be rated by expert panels or via appropriateness assessment protocols [12,[15][16][17]-for example, gauging the severity of patient symptoms and whether any indicated clinical interventions could have been provided elsewhere.…”

The Geriatric-Focused Emergency Department: Opportunities and Challenges

“…What is needed is more collaboration between hospitals, emergency departments, long-term care settings, and other outpatient providers; increased resources and activity around staff training in geriatric principles; and more research in this understudied and critical area of medical care. Incorporation of elements of geriatric assessment into routine emergency department practice around such issues as frailty assessment, 14e17 and tailoring of service delivery to persons with high frailty scores 18 Prognosis, risk, and functional trajectories of older persons who present for emergency care 19,20 Who, when, and under what circumstances to conduct diagnostic testing 21 Geriatric-specific guidelines for medication use 14 Appropriate use of emergency departments by long-term care facilities, and improved methods of acute care in the facility 13,22e25 Under what circumstances and how best to fold in discussion of and decision making regarding limitation of treatment, advance directives, and palliative care 26e28 Care of persons with Alzheimer's disease and related dementias in emergency department settings 29…”