Post-fall outcomes of aged care residents that did not transfer to hospital following referral to a specialised hospital outreach service: A retrospective cohort study

Abstract

BackgroundHospital outreach services aim to reduce the number of avoidable emergency department (ED) transfers of aged care residents and improve healthcare outcomes. While there are known benefits of such services, including avoiding the distress and discomfort that comes with the care transition, little is known about the outcomes of older people in residential aged care facilities who are referred to an outreach service and do not transfer to hospital after a fall. AimThe aim of this study was to describe the characteristics of residents who experienced a fall in an aged care facility and were referred to a hospital outreach service, and to report the health outcomes of those who did not transfer to hospital. MethodsA retrospective cohort study of health administrative data collected from 1st January 2019 to 31st May 2022 was undertaken. Clinical chart audits were conducted of aged care residents who avoided attending an ED following a fall but subsequently, within 30 days, died or presented to hospital. Descriptive statistics were used for analysis. FindingsMost residents who avoided the ED post fall (n = 370, 73%), did not present to hospital or die within 30 days. Of the cohort who presented to hospital within 30 days, the reasons included new symptoms, pain or medical imaging requirement. Of the residents who died (n = 42, 8%), most did not attend an ED within 30 days of the fall. DiscussionMost residents who were recommended not to transfer to an ED post fall by the hospital outreach service did not die or require transfer to hospital within 30 days. The residents who died had incurable progressive illness. Most of them who died were cared for in the aged care facility allowing the resident to die in a familiar environment being cared for by staff known to them. ConclusionThe results suggest that the hospital outreach service in this study was effective in most cases in supporting residents to avoid transfer to an ED post fall. Avoiding ED is not always appropriate.