Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia

Abstract

Objective: To estimate the appropriateness of emergency department (ED) presentations by people aged ≥ 65 years living in residential care facilities. 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.

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

“…Twenty-nine articles met the inclusion criteria [3,4,8-10,15,18-41]. Two articles reporting on the same study were considered as one source [21,38].…”

“…Some studies reported low proportions of inappropriate admissions. For example, Bermejo et al [35] and Finn et al [3] reported on 1.6% and 13.1% of inappropriate emergency department visits, respectively; Becker et al [33] reported on 18% of preventable hospitalisation. Other studies documented high proportions of inappropriate admissions.…”

“…LTC residents are often sent to emergency departments (ED) when they are in a highly acute condition, and are likely to be admitted to the hospital [2]. Common underlying diagnoses are pneumonia, urinary tract infection, congestive heart failure, chronic obstructive pulmonary disease, fall-related injuries, and altered conscious state [3,4]. …”

Systematic review of trends in emergency department attendances: an Australian perspective

“…Conversely, more recent studies from Canada and Australia determined that 85% of nursing home transfers were appropriate 74 75. Nevertheless, the Australian study identified evidence of primary care doctor involvement in only 25% of referrals, and a lack of clinical support for nursing home staff in general.…”

A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol

“…Despite this, approximately 60% of ED presentations lead to hospital admission [25, 26]. In an attempt to keep frail older persons at their place of residence during an acute illness, several MOC have been designed and tested.…”