Appropriateness of Emergency Department Transfers of Nursing Home Residents: Concordance Between Geriatrician and Emergency Physician Assessment in a Retrospective Study

Emergency department (ED) visits are frequent among nursing home residents, with one in four admitted at least once a year and one in ten admitted at least twice. The main objective of this study was to analyze ED visits by nursing home residents and to assess the concordance between the opinions of a geriatrician and an emergency physician This was a monocentric, retrospective, descriptive study conducted at the Rouen University Hospital ED. All elderly patients referred from nursing homes between January 1 and March 31, 2018, were included. The mean age of patients was 87.6 years, with a female-to-male ratio of 2.08. A Charlson comorbidity index >6 was found in 73% of cases, and only three medical records mentioned advance directives. Polypharmacy (≥7 medications) was present in 34% of cases, and dementia in 70%. The most common reason for ED referral was cardio-respiratory failure. The mean length of stay in the ED exceeded seven hours. Concordance analysis showed almost perfect agreement between geriatricians and emergency physicians, with a Cohen's kappa coefficient of 0.84. Overall, 68% of visits were deemed appropriate, 26.4% inappropriate, and 5.6% indeterminate. Chi-square analysis revealed a significant difference between the two groups regarding the FRENCH triage scale (p<0.01). Patients whose transfer was judged appropriate were significantly more likely to present with pain (p<0.01). The implementation of a relevance score could improve the evaluation of nursing home resident transfers to the ED, a decision that carries significant clinical consequences.