title: Emergency department access targets and the older patient: a retrospective cohort study of emergency department presentations by people living in residential aged care facilities.
abstract: BACKGROUND
  There is limited research on the effect of emergency access targets on health outcomes for older patients from Residential Aged Care Facilities. The aims were to: (1) identify length of stay for Residential Aged Care patients relative to access targets; and (2) examine hospital admission rates, readmission rates, inpatient costs and mortality.
  
  
  METHODS
  Retrospective cohort study of all emergency presentations for Residential Aged Care patients in 2009 at one Australian metropolitan health service.
  
  
  RESULTS
  The 4637 emergency presentations by 3184 Residential Aged Care patients in 2009 represented 3.4% of all emergency presentations. Mean length of stay was 7.9 hours (SD=4.5 hours); 84% of Residential Aged Care patients remained in the Emergency Department longer than four hours. Admitted patients were 3.6 times more likely to spend more than eight hours in the Emergency Department compared with those not admitted (p<0.001). Patients in the urgent triage category were 9.5 times more likely to spend more than eight hours in the Emergency Department compared to patients triaged as non-urgent (p<0.001). Inpatient costs were associated with length of admission and median cost per day was $AUD 1175.
  
  
  CONCLUSIONS
  Few Residential Aged Care patients were discharged within the four hours access target. This has implications for health care outcomes and costs associated with providing emergency care for patients living in Residential Aged Care Facilities.
authors.affiliation: School of Nursing & Midwifery, Deakin University, Burwood, Victoria 3125, Australia. maryann.street@deakin.edu.au
authors.forename: Maryann
authors.initials: M
authors.lastname: Street
authors.forename: Jonathon R
authors.initials: JR
authors.lastname: Marriott
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Livingston
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006707:Homes for the Aged; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D013997:Time Factors; D014218:Triage / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult