Background Emergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital. Methods This is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (≥ 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits—measured as ambulatory-care sensitive conditions (ACSCs)—were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis. Results Six percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p≤0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p≤0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p≤0.001) and laboratory resource use (334 tax points vs. 214, p≤0.001) were higher for potentially-avoidable ED visits. Conclusions We revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings’ public health implications.

Background increasing numbers of multimorbid patients living in long-term care (LTC) residential facilities are challenging ambulant care. In times of overcrowded emergency departments (ED), inappropriate ED visits need to be avoided to ensure optimal health care. This study aimed to determine and characterize inappropriate ED consultations of LTC residents including ED resource consumption. Methods this retrospective chart review was conducted at the ED of a Swiss tertiary hospital with a catchment area of about two million people. The analysis included 1’276 LTC-residents referred to the study centre between January 2015 and December 2017. Patient and consultation characteristics (age, gender, Charlson Comorbidity Index, as well as type and time of admission, length of stay in the ED, presence or absence of a consecutive hospitalization, and data on ED resource consumption) were extracted from the ED’s documentation system. Appropriateness was assessed using an established evaluation protocol. All variables were described in absolute numbers, percentages or median and interquartile range (IQR). Associations with inappropriateness status were tested with chi-square or Wilcoxon rank sum test respectively. A multivariable logistic regression analysis was preformed to identify predictors of inappropriate ED visits. Results The referred LTC-residents had a median age of 84 (IQR 78–89) years; 77 referrals (6.0%) were assessed as inappropriate. The final model revealed increased odds for an inappropriate admission for a less acute triage class and patients with connective tissue disease (both p ≤ 0.001), but lower odds for night-time admissions (p = 0.035) and the presence of cerebrovascular diseases (p = 0.043), respectively. The ED resource consumption differed significantly between appropriate and inappropriate visits (p ≤ 0.001). Conclusion Inappropriate admissions from nursing homes were low and less resource intensive than appropriate admissions. Preventive strategies focusing on high-quality ambulatory day-care might further reduce inappropriate emergency admissions.