Transfer of elderly patients from health care facilities to emergency departments: Prospective observational study of the emergency department in Japan

Abstract

Background: The purpose of the present paper is to describe the current status of emergency departments (ED) that are used by health care facilities for elderly (HCFFE) residents in Japan.Methods: The present paper is based on a prospective, observational study that was undertaken at a teaching hospital in Nagoya city over a 12‐month period. All patients transferred to the hospital ED from a regional HCFFE were analyzed. Demographic data, timing of the visit, the primary reason for transfer, diagnosis and disposition were recorded. The need for ambulance use was graded prospectively using three categories of urgency.Results: A total of 102 HCFFE residents made 116 ED visits. Their mean age was 83.3 years (range 58–101), 68% were female. The majority of patients (93%) were transferred by ambulance. Ambulance transfer was classified as emergency (20% of patients), urgent (51%) and routine (29%). The main reasons for patients to be transferred were fever (15.5%), fall (11.2%), altered mental status (10.3%), focal neurological deficits (10.3%), and weakness (9.5%). A total of 88% of the ED visits led to admission to the hospital. After admissions, the mean length of stay was 21.4 days and the mortality rate was 13%.Conclusion: Elderly patients staying in HCFFE are frequently transferred to an ED, and their visits are likely to lead to admission to the hospital, which is associated with prolonged lengths of stay as well as high mortality rates.