Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers

Guerbaaï, Raphaëlle-Ashley; Kressig, Reto W.; Zeller, Andreas; Tröger, Monika; Nickel, Christian H.; Benkert, Brigitte; Wellens, Nathalie; Osinska, Magdalena; Simon, Michaël; Zúñiga, Franziska

doi:10.1016/j.jamda.2022.01.063

Cited by 8 publications

(2 citation statements)

References 38 publications

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“…NH to ECF transfers is a topic with considerable interest internationally [ 6 ] due to the medical uncertainties and ethical considerations associated with transferring high risk and often terminally ill residents. As a result, several Delphi studies have been conducted to find consensus on transfers [ 31 – 35 ]. There has been a lack of studies on warranted and unwarranted transfers from NH to ECF in Norway since 2013 [ 2 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Wiik,

Doupe,

Bakken

et al. 2024

BMC Health Serv Res

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Background Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. Methods A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. Results Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. Conclusions Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.

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Section: Discussionmentioning

confidence: 99%

Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Wiik,

Doupe,

Bakken

et al. 2024

BMC Health Serv Res

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“…Trauma could be associated with the routine moving of NH residents by nursing staff or healthcare assistants, which could lead to falls or injuries that require in-depth evaluation through ED visits [ 51 – 54 ]. Falls represented one of the main reasons for NH residents’ ED visits, responsible for 25–87% of ED visits or hospitalizations with at least one night’s stay [ 51 , 54 , 55 ]. Recently, one in four fall-related transfers from NH was rated potentially avoidable, by developing partnerships with outpatient clinics for imaging services, and strengthening geriatric expertise in NH through clinical training and advanced nurse practitioners [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

Albanesi,

Conti,

Politano

et al. 2024

BMC Geriatr

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Background Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. Methods A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. Results In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51–1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08–2.31). Conclusions Our study indicates that more than half of NH residents’ ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.

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A balancing act: falling versus aging

Ting,

Ting

2024

Discov Med

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Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers

Cited by 8 publications

References 38 publications

Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

A balancing act: falling versus aging

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