Out of Hours Emergency Department Admissions of Nursing Home Residents

Abstract Background Nursing home residents (NHRs) represent a complex and growing patient population with increasing Emergency Department (ED) attendances. Their care frequently requires multidisciplinary input, while specialised geriatric services tailored to this cohort exist, their availability is often limited to daytime hours. Methods A retrospective analysis was conducted on out of hours medical ED admissions of NHRs over a six month period, from November 2023 to April 2024. Data collected included demographics, time of arrival, presenting complaints, clinical acuity, and length of stay. Out of hours was defined as attendance after 17:00 on weekdays and anytime during weekends or public holidays. Results A total of 77 (60.2%) NHRs medical admissions occurred out of hours, with 45.5% presenting by 21:00. Infectious symptoms were the most common presenting complaints, accounting for 48.1%, (n=37), followed by gastrointestinal issues with 14.3%, (n=11) and neurological problems at 13%, (n=10). Upon arrival, 58.8% (n=45) were triaged as category 2 (very urgent) according to the Manchester Triage System, 26% (n=20) met sepsis criteria and 16.9% (n=13) had an oxygen requirement. The average duration of symptoms before presentation was 2.08 days (0–14). The average ED stay was 0.86 days, with a mean inpatient length of stay of 9.33 days. The three month mortality rate was 24.7%, with 7.68% (n=6) of NHRs dying during their inpatient stay. Conclusion This study demonstrates that the majority of NHRs presented to ED outside of regular working hours, when specialised geriatrician led services are limited. A significant number did not meet sepsis criteria or had a new oxygen requirement. Their three monthly mortality was 24.7%. These findings support the need to consider enhanced, ambulatory nursing homes outreach services, to deliver timely, and coordinated care, and potentially reduce ED presentations.