The interface between residential aged care and the emergency department: a systematic review.
BACKGROUND
emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known.


METHODS
systematic review based on a comprehensive literature search in three electronic databases and published article reference lists.


RESULTS
the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care.


CONCLUSIONS
residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.
Arendts
Glenn
G
Emergency Medicine, Centre for Clinical Research in Emergency Medicine, Western Australian Centre for Medical Research, Royal Perth Hospital, University of Western Australia. glenn.arendts@uwa.edu.au
Howard
Kirsten
K
D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000145:classification* / Q000458:organization & administration; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010360:Patient Transfer / Q000706:statistics & numerical data*