title: Nursing home residents at the Emergency Department: a 6-year retrospective analysis in a Swiss academic hospital.
abstract: The increasing number of elderly persons produces an increase in emergency department (ED) visits by these patients, including nursing home (NH) residents. This trend implies a major challenge for the ED. This study sought to investigate ED visits by NH residents in an academic hospital. A retrospective monocentric analysis of all ED visits by NH residents between 2005 and 2010 in a Swiss urban academic hospital. All NH residents aged 65 years and over were included. Socio-demographic data, mode of transfer to ED, triage severity rating, main reason for visit, ED and hospital length of stay, discharge dispositions, readmission at 30 and 90 day were collected. Annual ED visits by NH residents increased by 50 % (from 465 to 698) over the study period, accounting for 1.5 to 1.9 % of all ED visits from 2005 to 2010, respectively. Over the period, yearly rates of ED visits increased steadily from 18.8 to 27.5 per 100 NH residents. Main reasons for ED visits were trauma, respiratory, cardiovascular, digestive, and neurological problems. 52 % were for urgent situations. Less than 2 % of NH residents died during their ED stay and 60 % were admitted to hospital wards. ED use by NH residents disproportionately increased over the period, likely reflecting changes in residents and caregivers' expectations, NH staff care delivery, as well as possible correction of prior ED underuse. These results highlight the need to improve ED process of care for these patients and to identify interventions to prevent potentially unnecessary ED transfers.
authors.affiliation: Emergency Department, Lausanne University Hospital, Lausanne, Switzerland. pierre-nicolas.carron@chuv.ch.
authors.forename: Pierre-Nicolas
authors.initials: PN
authors.lastname: Carron
authors.affiliation: University of Health Sciences (HESAV), Lausanne, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Mabire
authors.affiliation: Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.affiliation: Service of Geriatric Medicine, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Büla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013557:Switzerland
keywords: Ageing; Appropriateness; Emergency department; Nursing home residents