NURSING HOMES CHARACTERISTICS ACCORDING TO THE RATE OF EMERGENCY DEPARTMENT TRANSFER: A RETROSPECTIVE STUDY
K. El Haddad , X. Dubusc, C. Cool, F. Nourhashémi, P. De Souto Barreto, Y. Rolland
Jour Nursing Home Res 2018;4:5-9
Background: Despite comparable clinical characteristics of nursing home residents, the rate of emergency department transfer is highly variable from one nursing home to another, suggesting that structural characteristic and organizational factors may influence the rate of nursing home resident’s transfer to the emergency department. Objectives: To identify structural characteristics and medical care organization of nursing homes according to the rate of emergency department transfers of nursing home residents. Design: We conducted a cross-sectional analysis using the baseline data of the IQUARE study (Impact of a QUAlity improvement initiative on nursing practices and functional decline in NH REsidents), a non-randomized controlled multicenter trial with 175 nursing homes in south-western, France. Participants: 5926 nursing home residents. Measurement: Data on nursing home structural characteristics and medical care organization were collected by questionnaires between May and July 2011. Data concerning hospital admissions and emergency department transfers during the past year were retrieved from the residents’ medical files. Results: The rate of emergency department transfer in the last 12 months was 18.9% (±11.5): 7.4%, 18.4% and 31.4% for the low, medium and high tertile groups, respectively. Compared to the low transfer group, the high transfer group had less special care unit (RRR: 0.31, 95%CI 0.19-0.83, P: 0.018). The location of the high transfer group tends to be more urban than rural when compared to the low transfer group (RRR: 0.37, 95%CI 0.14-0.99, P: 0.047). Compared to the low transfer group, the high transfer group has less pharmacy for internal use (RRR: 0.10, 95%CI 0.03-0.38, P < 0.001). Conclusion: Our results suggest that implementing special care unit and pharmacy for internal use in nursing homes may reduce the rate of nursing home residents’ transfer to the emergency department. Geographic location seems to dissuade or encourage nursing home to transfer residents to the emergency department. Long-term interventions are needed to reduce the risk of inappropriate emergency department transfers, thus the risk and cost associated with hospitalization.
K. El Haddad ; X. Dubusc ; C. Cool ; F. Nourhashémi ; P. De Souto Barreto ; Y. Rolland (2018): Nursing homes characteristics according to the rate of emergency department transfer: a retrospective study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.2