Abstract
BackgroundUnplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. However, there is little research on what diagnostic and therapeutic measures are performed during visits.AimsWe analyzed underlying diagnoses, characteristics and performed medical procedures of unplanned outpatient ED visits by NHR.MethodsWe conducted a multi-center study of 14 nursing homes (NHs) in northwestern Germany in 03/2018–07/2019. Hospital transfers were documented by nursing staff using a standardized questionnaire for 12 months. In addition, discharge letters were used to collect information about the respective transfer, its reasons and the extend of the medical services performed in the ED.ResultsA total of 161 unplanned ED visits were included (mean age: 84.2 years; 68.3% females). The main transfer reasons were trauma (59.0%), urinary catheter and nutritional probe problems (overall 10.6%; male NHR 25.5%) and altered mental state (9.9%). 32.9% where discharged without imaging or blood test prior. 67.4% of injured NHR (n = 95) required no or only basic wound care. Catheter-related problems (n = 17) were mainly treated by changing an existing suprapubic catheter (35.3%) and by flushing the pre-existing catheter (29.4%).DiscussionOur data suggest that the diagnostic and therapeutic interventions performed in ED, often do not exceed general practitioner (GP) care and many ED visits seem to be unnecessary.ConclusionBetter coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits.
Highlights
The prevalence of emergency department (ED) visits rises with age and is high among nursing home residents (NHR)
The most common reasons for such transfers are trauma, altered mental state and infections [8] and we recently found that 75.0% of NHR not subsequently hospitalized were diagnosed with traumatic injuries [12]
A total of 240 ED transfers occurred, which did not lead to hospitalisation. 68 questionnaires were returned without a discharge letter and, excluded
Summary
The prevalence of emergency department (ED) visits rises with age and is high among nursing home residents (NHR). These patients are a vulnerable, frail and multimorbid group, who suffer from numerous medical comorbidities leading to increased medical complexity [1, 2]. Transfers can be burdensome to NHR, because it puts them at risk for in-hospital complications such as pressure ulcers, delirium, iatrogenic infections, and increased mortality [4,5,6] Those ED visits which do not lead to hospitalization are described as avoidable or inappropriate by many authors [7,8,9]. Unplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. Conclusion Better coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits
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