Preventing Hospitalisation- Providing Specialist Geriatric Services To Nursing Home Patients

Abstract Background Nursing home (NH) residents often require acute hospital care in unexpected deterioration and may have repeated Emergency Department (ED) attendances. Grunier et al (2018) reported 48% of NH residents reattend ED within 1 year. Our aim is to determine if those who require acute hospital admission are more likely to reattend ED or require NH outreach services. Methods Nursing home residents who attended Mater ED in March 2023 were identified through Electronic Patient Record. Their age, gender, reattendance of ED within 28 days and 6 months, visit by NH outreach team within 28 days then 6 months and 6-month mortality were recorded. The residents were categorised as admitted or discharged from their sentinel visit in March 2023. Chi-square test was used, and statistical significance was set at p0.05. Results Sixty-three nursing home residents attended within 1-month, median age 85 years (range 67-95), 43 were women. Forty-five (71%) required admission, 6 (9.5%) and 24 (38.1%) reattended ED within 28 days and 6 months respectively. There was no difference in 28-day or 6-month ED reattendance between those who were admitted or discharged in the sentinel visit to ED. Those discharged from ED were more likely to receive NH outreach visit within 28 days (84% vs 6.8%) and 6 months (84% vs 11%) than those who were admitted, p0.0001. There was no difference in 6 months mortality between the groups. Conclusion Our study found that 71% of NH residents who attend ED require admissions showing that the transfer was warranted. More than one-third of NH residents reattend ED within 6 months. Those discharged from ED were more likely to be reviewed by NH outreach team as per service delivery. Working closely with the resident’s General Practitioner, NH and ED staff may help to manage these complex patients to coordinate their treatment and prevent ED reattendance.