Design, setting and participants: Retrospective cohort study of older residents of residential care facilities who presented to the ED of the Royal Perth Hospital, Western Australia, between January and June 2002. Data were reviewed by an expert clinical panel.
Main outcome measures: Appropriateness of ED presentation, presenting complaint, involvement of a general practitioner/locum doctor prior to transfer, proportion of patients admitted to hospital from the ED, survival to discharge.
Results: 541 residents aged ≥ 65 years were transferred by ambulance to the ED, comprising 8.3% of all ED presentations of people in this age group. The mean age of the study cohort was 83.7 years (SD, 7.0 years), of which 68% were women. Of the 541 presentations, 326 (60%) resulted in hospital admission, and of these, 276 (85%) survived to hospital discharge. Musculoskeletal disorders accounted for 25% of all presentations, and 22% were falls-related; pneumonia (11% of presentations) was the single largest presenting complaint. ED attendance was deemed “inappropriate” for 71/541 cases (13.1%; 95% CI, 10.5%–16.2%); in only 25% of ED presentations was a GP/locum doctor involved prior to transfer.
Conclusions: The majority of ED presentations by aged care residents were considered to be appropriate, but there was scope for improvement in coordinating care between the hospital ED and residential care institutions.
- 1. Bergman H, Clarfield AM. Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions. J Am Geriatr Soc 1991; 39: 1164-1168.
- 2. Ackermann RJ, Kemle KA, Vogel RL, Griffin RC. Emergency department use by nursing home residents. Ann Emerg Med 1998; 31: 749-757.
- 3. Madden C, Garrett J, Busby-Whitehead J. The interface between nursing homes and emergency departments: a community effort to improve transfer of information. Acad Emerg Med 1998; 5: 1123-1126.
- 4. Barker W, Zimmer JG, Hall W, et al. Rates, patterns, causes, and costs of hospitalization of nursing home residents. Am J Public Health 1994; 84: 1615-1620.
- 5. Friedmann PD, Jin L, Karrison TG, et al. Early revisit, hospitalization, or death among older persons discharged from the ED. Am J Emerg Med 2001; 19: 125-129.
- 6. Fried TR, Mor V. Frailty and hospitalization of long-term stay nursing home residents. J Am Geriatr Soc 1997; 45: 265-269.
- 7. Jones JS, Dwyer PR, White LJ, Firman R. Patient transfer from nursing home to emergency department: outcomes and policy implications. Acad Emerg Med 1997; 4: 908-915.
- 8. Saliba D, Kington R, Buchanan J, et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc 2000; 48: 154-163.
- 9. Kayser-Jones JS, Wiener CL, Barbaccia JC. Factors contributing to the hospitalization of nursing home residents. Gerontologist 1989; 29: 502-510.
- 10. Ackermann RJ. Nursing home practice. Strategies to manage most acute and chronic illnesses without hospitalization. Geriatrics 2001; 56: 37, 40, 43-44 passim.
- 11. Finucane PM, Wundke R, Whitehead C, et al. Profile of people referred to an emergency department from residential care. Aust N Z J Med 1999; 29: 494-499.
- 12. Finucane P, Wundke R, Whitehead C, et al. Use of in-patient hospital beds by people living in residential care. Gerontology 2000; 46: 133-138.
- 13. Fatovich DM. Responses to access block in Australia: Royal Perth Hospital. Med J Aust 2003; 178: 108-109. <MJA full text>
- 14. Finn J. Prognostic determinants of out-of-hospital cardiac arrest in Perth, Western Australia: identification of strategies to improve outcome [PhD thesis]. Perth: University of Western Australia, 2002.
- 15. Baggoley C, Phillips D, Aplin P. A study of emergency admissions at the Flinders Medical Centre using the Appropriateness Evaluation Protocol. Emerg Med 1994; 6: 29-36.
- 16. Kihlgren AL, Nilsson M, Sorlie V. Caring for older patients at an emergency department — emergency nurses’ reasoning. J Clin Nurs 2005; 14: 601-608.
- 17. Australian Government Department of Health and Ageing. Aged Care GP Panels Initiative. Statement of rationale for the Divisions’ performance indicators. 2004. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-medicare-health_pro-gp-rationale.htm (accessed Mar 2006).
- 18. Mylotte JM, Naughton B, Saludades C, Maszarovics Z. Validation and application of the pneumonia prognosis index to nursing home residents with pneumonia. J Am Geriatr Soc 1998; 46: 1538-1544.
- 19. Thompson RS, Hall NK, Szpiech M. Hospitalization and mortality rates for nursing home-acquired pneumonia. J Fam Pract 1999; 48: 291-293.
- 20. Freiman MP, Murtaugh CM. The determinants of the hospitalization of nursing home residents. J Health Econ 1993; 12: 349-359.
- 21. Australian Department of Health and Ageing. National Demonstration Hospitals Program Phase 4. National evaluation of project impact. Final report. 2003. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-hospitals-demonstration-NDHP (accessed Mar 2006).
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