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Abstract Background Nursing home residents (NHRs) often face hospital admissions through the emergency department (ED), leading to complications such as delirium, pressure ulcers, and functional decline. To mitigate these risks, ED avoidance models of care are becoming increasingly popular within healthcare systems. These models advocate for ambulatory pathways that provide access to multidisciplinary teams capable of delivering timely care for patients who do not require hospital admission. Methods A retrospective review of clinical data spanning 14 months (February 2023 to April 2024) was conducted, focusing on NHRs admitted to hospital for less than three days. Data were collected from electronic patient records, including age, sex, reason for admission, National Early Warning Score (NEWS), Manchester Triage (MT) score at admission, and length of stay in the ED. Results 325 NHRs were admitted medically during the study period. 18.7% (n=61) had inpatient stays of less than 36 hours. The most common reasons for ED presentation were lower respiratory tract infections, seizures, collapse or falls, and delirium. Of these patients, 51%(n=32) had a NEWS of ≤2, indicating low acuity, while 38% had an MT score of ≤3, suggesting lower urgency. The average patient experience time in the ED was 15.88 hours. Conclusion Approximately half of all short stay NHR admissions exhibited low acuity NEWS scores at the time of presentation, indicating the potential for an ambulatory care pathway for over 10% of all our NHR admissions. Implementing an ED avoidance pathway through our Acute Medical Unit could allow many of these patients to receive appropriate care without long periods in the ED, thereby reducing potential complications. These findings highlight opportunities to streamline care pathways and reduce unnecessary hospitalisations for NHRs. Implementing an ED avoidance service tailored to the specific needs of these patients could enhance care efficiency and improve patient outcomes.
Farrelly et al. (Sun,) studied this question.