title: A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities.
abstract: BACKGROUND
  residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital.
  
  
  METHODS
  a comprehensive search of the peer-reviewed literature using four electronic databases. Inclusion criteria were participants lived in nursing homes, care homes or long-term care, aged at least 65 years, and studies reported outcomes of acute ED transfer or hospital admission. Findings were synthesized and key factors identified.
  
  
  RESULTS
  residents of RACF frequently presented severely unwell with multi-system disease. In-hospital complications included pressure ulcers and delirium, in 19 and 38% of residents, respectively; and up to 80% experienced potentially invasive interventions. Despite specialist emergency care, mortality was high with up to 34% dying in hospital. Furthermore, there was extensive use of healthcare resources with large proportions of residents undergoing emergency ambulance transport (up to 95%), and inpatient admission (up to 81%).
  
  
  CONCLUSIONS
  acute emergency department (ED) transfer is a considerable burden for residents of RACF. From available evidence, it is not clear if benefits of in-hospital emergency care outweigh potential adverse complications of transfer. Future research is needed to better understand patient-centred outcomes of transfer and to explore alternative models of emergency healthcare.
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia.
authors.forename: Rosamond
authors.initials: R
authors.lastname: Dwyer
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Gabbe
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Johannes U
authors.initials: JU
authors.lastname: Stoelwinder
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Lowthian
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000552:Ambulances / Q000191:economics / Q000706:statistics & numerical data; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D016330:Frail Elderly; D005853:Geriatrics / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006707:Homes for the Aged; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010343:Patient Admission / Q000191:economics; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: emergency; nursing homes; older people