Organizational and environmental factors associated with transfers of nursing home residents to emergency departments

Variations in older people's emergency care use by social care setting: a systematic review of international evidence

BACKGROUND

Older adults' use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings.

SOURCES OF DATA

A systematic review was conducted, searching six electronic databases between January 2012 and February 2022.

AREAS OF AGREEMENT

Older people access emergency care from a variety of community settings.

AREAS OF CONTROVERSY

Differences in study design contributed to high variation observed between studies.

GROWING POINTS

Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting.

AREAS TIMELY FOR DEVELOPING RESEARCH

There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies.

A Scoping Literature Review of Rural Institutional Elder Care

Under circumstances of pervasive global aging combined with weakened traditional family elder care, an incremental demand for institutional elder care is generated. This has led to a surge in research regarding institutional elder care. Rural residents' institutional elder care is receiving more attention as a major theme in social sciences and humanities research. Based on 94 articles related to rural institutional elder care, this study identified the most influential articles, journals and countries in rural institutional elder care research since 1995. This was done using science mapping methods through a three-step workflow consisting of bibliometric retrieval, scoping analysis and qualitative discussion. Keywords revealed five research mainstreams in this field: (1) the cognition and mental state of aged populations, (2) the nursing quality and service supply of aged care institutions, (3) the aged care management systems' establishment and improvements, (4) the risk factors of admission and discharge of aged care institutions, and (5) deathbed matters regarding the aged population. A qualitative discussion is also provided for 39 urban and rural comparative research papers and 55 pure rural research papers, summarizing the current research progress status regarding institutional elder care systems in rural areas. Gaps within existing research are also identified to indicate future research trends (such as the multi-dimensional and in-depth comparative research on institutional elder care, new rural institutional elder care model and technology, and correlative policy planning and development), which provides a multi-disciplinary guide for future research.

Factors associated with increased Emergency Department transfer in older long-term care residents: a systematic review

The proportion of adults older than 65 years is rapidly increasing. Care home residents in this age group have disproportionate rates of transfer to the Emergency Department (ED) and around 40% of attendances might be avoidable. We did a systematic review to identify factors that predict ED transfer from care homes. Six electronic databases were searched. Observational studies that provided estimates of association between ED attendance and variables at a resident or care home level were included. 26 primary studies met the inclusion criteria. Seven common domains of factors assessed for association with ED transfer were identified and within these domains, male sex, age, presence of specific comorbidities, polypharmacy, rural location, and care home quality rating were associated with likelihood of ED transfer. The identification of these factors provides useful information for policy makers and researchers intending to either develop interventions to reduce hospitalisations or use adjusted rates of hospitalisation as a care home quality indicator.

Immobilität als Grund der Vorstellung in einer Krankenhausnotaufnahme?

Hintergrund

Die zunehmende Belastung von Krankenhausnotaufnahmen (KHN) durch wenig dringliche Patienten wirft Fragen nach Fehlsteuerungen bzw. Versorgungsdefiziten in anderen Bereichen auf.

Methode

Retrospektive Datenanalyse einer Zufallsstichprobe aus allen Fällen des Jahres 2019 zweier KHN in einer Metropolregion. Wir untersuchten Patienten, die ambulant versorgt, aber mit einem Krankentransportmittel (KT) wieder aus der Notaufnahme abtransportiert wurden.

Ergebnisse

1500 Patienten (767 [51,1 %] weiblich; Alter 56 ± 22,7 Jahre) aus einer Grundgesamtheit von 80.845 Patienten wurden analysiert. 888 (59,2 %) wurden ambulant versorgt. Jeweils 9 (0,5 %), 193 (12,9 %), 684 (45,6 %), 508 (33,9 %) und 48 (3,2 %) waren den Manchester-Triage-System-Kategorien Rot, Orange, Gelb, Grün bzw. Blau zugeordnet. Von 880 ambulanten Patienten wurden 731 (83,2 %) selbstständig und 149 (16,8 %) mit einem KT entlassen. Über die Hälfte der per KT entlassenen Patienten war mit urologischen Problemen, Extremitätenproblemen und nach Stürzen vorgestellt worden. Die liegend transportierten ambulant versorgten Patienten hatten ein höheres Alter (76,2 ± 16,2 vs. 45,1 ± 20,5 Jahre; p < 0,001), einen höheren Charlson Comorbidity Index (5 [3–6] vs. 0 [0–2]; p < 0,001), erhielten seltener eine CT-Diagnostik und häufiger lediglich eine einfache medizinische Maßnahme ohne diagnostischen Aufwand (24,8 % vs. 4,6 %; p < 0,001). Sie wurden zu einem größeren Anteil mehrfach vorgestellt (28,9 % vs. 8,5 %; p < 0,001). Der Anteil an Heimbewohnern war höher (59,5 % vs. 0 %; p < 0,001).

Schlussfolgerung

Etwa ein Zehntel der insgesamt in den KHN versorgten Patienten blieb ambulant und wurde mit einem KT entlassen. Mehr als die Hälfte wurde aus stationären Pflegeeinrichtungen vorgestellt. Ein Großteil erhielt einfache Leistungen und kaum Diagnostik und hatte eine niedrige Triagedringlichkeit.

Feasibility of Using a Risk Assessment Tool to Predict Hospital Transfers or Death for Older People in Australian Residential Aged Care. A Retrospective Cohort Study

Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the feasibility of identifying an end-of-life risk profile among RACF residents using a predictive tool to better anticipate predictors of hospital transfers, death or poor composite outcome of hospitalisation and/or death after initial assessment. A retrospective cohort study of 373 permanent residents aged 65+ years was conducted using objective clinical factors from records in nine RACFs in metropolitan Sydney, Australia. In total, 26.8% died and 34.3% experienced a composite outcome. Cox proportional hazard regression models confirmed the feasibility of estimating the level of risk for death or a poor composite outcome. Knowing this should provide opportunities to initiate advance care planning in RACFs, facilitating decision making near the end of life. We conclude that the current structure of electronic RACF databases could be enhanced to enable comprehensive assessment of the risk of hospital re-attendance without admission. Automation tools to facilitate the risk score calculation may encourage the adoption of prediction checklists and evaluation of their association with hospital transfers.