Emergency department presentations and 30-day mortality in patients from residential aged care facilities

Abstract

Objective To describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF). Methods A retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages. All patients aged ≥65 years presenting to the ED from a RACF between January 2017 and July 2018 were included. ED diagnosis categories, re-admission rates within 30 days and 30-day all-cause mortality were measured. Results In total, 43 248 presentations were identified. The most common ED diagnosis categories were: injury (26.48%), respiratory conditions (14.12%) and cardiovascular conditions (10.74%). Prolonged ED length of stay was associated with higher adjusted hazard ratios for 30-day all-cause mortality after adjustments for age Charlson Comorbidity Index, triage category and diagnosis category (HR 1.10 95% CI 1.05–1.14 P < 0.001). Conclusions A large proportion of ED presentations from RACFs were for injuries associated with falls and chest infections. There was a range of both high- and low-urgency presentations. Both the 30-day mortality and re-admission rates were high. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. The findings are useful in informing discussion around improving access to care in RACFs and coordination of healthcare providers in this cohort.

Retrospective observational study of aged care facility residents presenting to ED post fall: A case for person‐centred shared decision making

“…The all-cause 30-day mortality in the study population was 11.9%, similar to findings by Chiswell et al 6 The 30-day mortality of all patients with a deviation from their neurological baseline was similar to those with intracranial haemorrhage. The management of intracranial haemorrhage remained conservative, and often involved palliation which is consistent with earlier studies.…”

“…The all‐cause 30‐day mortality in the study population was 11.9%, similar to findings by Chiswell et al 6 . The 30‐day mortality of all patients with a deviation from their neurological baseline was similar to those with intracranial haemorrhage.…”

“…reasons for transfer to ED, which is similar in prevalence to respiratory (12-37%) and cardiovascular disease (11-28%). 5,6 In Australia RACF clinicians manage residents who fall by adhering to the standards set by the Aged Care Quality and Safety Commission. 7 An industry alert to all RACF providers in 2016 recommended that residents who fall with a suspected head injury, especially those on anticoagulants, should be assessed in hospital.…”

“…Around 60% of all residents experience a fall every year, 37% are injurious and 10% are transferred to hospital for treatment 3,4 . Of all ED presentations from an RACF, falls make up 12–23% of reasons for transfer to ED, which is similar in prevalence to respiratory (12–37%) and cardiovascular disease (11–28%) 5,6 . In Australia RACF clinicians manage residents who fall by adhering to the standards set by the Aged Care Quality and Safety Commission 7 .…”