Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers

Aryal, Komal; Mowbray, Fabrice; Gruneir, Andrea; Griffith, Lauren; Howard, Michelle; Jabbar, Amina; Jones, Aaron; Tanuseputro, Peter; Lapointe‐Shaw, Lauren; Costa, Andrew P

doi:10.1016/j.jamda.2021.11.020

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Indeed, the progressive loss of autonomy, increased risk of immobility, and reduced cognitive performance clearly influences the health status of NH residents. This could exacerbate symptoms of existing conditions that may be difficult to attribute to a specific problem during triage [ 19 ]. Additionally, many NH residents are unable to report any changes in their health status or provide indications of the onset of new symptoms [ 48 ] and it is not unusual that on transfer to ED, residents commonly present information gaps and lack detailed clinical documentation from the NH, which may affect the admission diagnosis and assignment of ED code [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, ED visits involve significant use of health resources: approximately 95% of transfers from NH are made by ambulance, causing long ED waits, which contributes to ED overcrowding and overwork of professionals [ 13 – 15 ]. Although several studies [ 10 – 19 ] have identified the inadequacy of ED visits and their possible reduction through better clinical management of residents within the actual NH, the number of ED visits from NH is still high [ 15 – 20 ]. Arendts and colleagues [ 21 ] in their systematic review, showed that the percentage of ED visits by NH residents represents 0.4–2.4% of all ED visits yearly.…”

Section: Introductionmentioning

confidence: 99%

“…Although reasons for ED visits are often underreported, the lack of consensus on the appropriateness of visits and specific care pathways for NH residents are among the leading causes of ED visits [ 5 , 21 – 24 ]. In particular, the characteristics and factors related to ED visits remain unclear [ 5 , 19 , 24 ]. Hence, to enable NH residents to receive suitable care for their conditions and avoid inappropriate and potentially harmful hospitalizations, a better understanding is needed of the factors underlying transfer processes and ED visits [ 19 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the characteristics and factors related to ED visits remain unclear [ 5 , 19 , 24 ]. Hence, to enable NH residents to receive suitable care for their conditions and avoid inappropriate and potentially harmful hospitalizations, a better understanding is needed of the factors underlying transfer processes and ED visits [ 19 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

Albanesi,

Conti,

Politano

et al. 2024

BMC Geriatr

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Background Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. Methods A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. Results In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51–1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08–2.31). Conclusions Our study indicates that more than half of NH residents’ ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

Albanesi,

Conti,

Politano

et al. 2024

BMC Geriatr

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“…Our findings correspond with previous studies that have also described that a greater number of comorbidities,6 12 13 more severe symptoms (such as dyspnoea)14 and less than 1 year of survival after diagnosis13 15 were all associated with higher rates of ED utilisation. The higher ED utilisation frequency and potentially preventable ED transfers by nursing home residents has only recently been investigated,16 but data on the frequency of ED utilisation by patients with cancer living in nursing homes is scarce. Our analysis showed that living in a nursing home more than tripled the odds and thus was a strong risk factor for repeated ED utilisation.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of cancer patients’ predictive factors of care in a large, Hungarian tertiary care centre

et al. 2023

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ObjectivesTo identify predictive factors of multiple emergency department (ED) visits, hospitalisation and potentially preventable ED visits made by patients with cancer in a Hungarian tertiary care centre.DesignObservational, retrospective study.SettingA large, public tertiary hospital, in Somogy County, Hungary, with a level 3 emergency and trauma centre and a dedicated cancer centre.ParticipantsPatients above 18 years with a cancer diagnosis (International Classification of Diseases, 10th Revision codes of C0000–C9670) who visited the ED in 2018, who had received their diagnosis of cancer within 5 years of their first ED visit in 2018 or received their diagnosis of cancer latest within the study year. Cases diagnosed with cancer at the ED (new cancer diagnosis-related ED visits) were also included, constituting 7.9% of visits.Primary outcome measuresDemographic and clinical characteristics were collected and the predictors of multiple (≥2) ED visits within the study year, admission to inpatient care following the ED visit (hospitalisation), potentially preventable ED visits and death within 36 months were determined.Results2383 ED visits made by 1512 patients with cancer were registered. Predictive factors of multiple (≥2) ED visits were residing in a nursing home (OR 3.09, 95% CI 1.88 to 5.07) and prior hospice care (OR 1.87, 95% CI 1.05 to 3.31). Predictive factors for hospitalisation following an ED visit included a new cancer diagnosis-related visit (OR 1.86, 95% CI 1.30 to 2.66) and complaint of dyspnoea (OR 1.61, 95% CI 1.22 to 2.12).ConclusionsBeing a resident of a nursing home and receiving prior hospice care significantly increased the odds of multiple ED visits, while new cancer-related ED visits independently increased the odds of hospitalisation of patients with cancer. This is the first study to report these associations from a Central-Eastern European country. Our study may shed light on the specific challenges of EDs in general and particularly faced by countries in the region.

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The Geriatric-Focused Emergency Department: Opportunities and Challenges

Sloane

2022

Journal of the American Medical Directors Association

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Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers

Cited by 10 publications

References 25 publications

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

Retrospective study of cancer patients’ predictive factors of care in a large, Hungarian tertiary care centre

The Geriatric-Focused Emergency Department: Opportunities and Challenges

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