Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study.

Lijun Fan,Kaeleen Dingle,Sam Tapp,Jingzhou Zhao,Bill Lukin,Jiandong Sun,Xiang-Yu Hou,Rhonda Purtill

doi:10.1186/s12913-016-1275-z

Abstract

BackgroundThere has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs).MethodsA quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis.ResultsSignificant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196).ConclusionsHospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Highlights

There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding
There were 449 ED presentations and 256 hospital admissions to Royal Brisbane and Women’s Hospital (RBWH) from 2127 residential aged care facilities (RACF) beds in the three-month pre-intervention period, while were 393 ED presentations and 196 hospital admissions from 2485 RACF beds in the three-month post-intervention period from June to August 2011
Compared with the pre-test period, there was no significant change in the number of ED presentations from RACFs in the control hospital; while there was a significant reduction in ED presentations in the experimental hospital after the intervention

Summary

Introduction

Residents have disproportionately high demands for acute medical services, and they frequently present to emergency departments (EDs) and many require hospital admission from ED [2,3,4]. Their visits are often unnecessary owing to their relatively minor and repeated health problems, or serious chronic disease without appropriate end-of-life care plans. Unnecessary ED presentations and hospital admissions by RACF residents put further pressure on already overtaxed services, potentially further exacerbating ED and hospital overcrowding and compromising access to timely and high-quality acute care [5, 6]. Unnecessary hospital attendances can simultaneously expose residents to potential complications, such as hospital-acquired infections, falls, and disorientation, and decrease their quality of life [7]

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