NURSING HOME RESIDENTS IN EMERGENCY DEPARTMENT: RISK FACTORS OF INAPPROPRIATE OR POTENTIALLY AVOIDABLE TRANSFERS. RESULTS OF FINE PILOT STUDY
I. Binot, N. Tavassoli, E. Berard, A. Perrin, S. Bismuth, E. Giovanni, A. Lafourcade, B. Vellas, Y. Rolland
Jour Nursing Home Res 2017;3:28-37
Background: Transfer of residents from nursing home (NH) to emergency department (ED) can be inappropriate or potentially avoidable. Objectives: To determine the rate of inappropriate (IT) or potentially avoidable (PAT) transfers of NH residents to ED and to identify the factors associated with these transfers. Setting: Two emergency departments of Toulouse University Hospital, France. Design: All residents arriving at the ED during one week were included. Data were collected, the day of the resident’s transfer, by face to face interviews with the ED’s practitioner and by phone call to the general practitioner (GP) or the health professional in the NH who decided the transfer. An independent panel of experts in geriatrics, pharmacy, emergency and family medicine assessed the appropriateness and potentially avoidable profile of transfers. Results: Fifty-four residents were included. 43% (n=23) considered as IT and 48% (n=26) as PAT. The main factors associated with IT was a low score on basic ADL (Activities of Daily Living) (p=0.03), the need of physician to be reassured about the resident’s pathology (p=0.03) and a lack of technical support in the NH (p=0.03). Iatrogenic medication was found in 44% of the resident with PAT. Before the transfer to ED and after the return in NH, there was a significant increase in diagnosis of dementia (p=0.01) and a non-significant decline in residents’ functional status (ADL score) (p=0.05). Conclusion: This pilot study suggested that factors associated with IT and PAT are related to the clinical characteristics of the residents, the isolation of the NH and the poor quality of prescription. Some factors seem accessible to improvement.
I. Binot ; N. Tavassoli ; E. Berard ; A. Perrin ; S. Bismuth ; E. Giovanni ; A. Lafourcade ; B. Vellas ; Y. Rolland (2017): Nursing Home residents in emergency department: risk factors of inappropriate or potentially avoidable transfers. Results of FINE pilot study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.5