title: Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy.
abstract: To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions.
  
  
  
  Prospective multicenter study.
  
  
  
  Burgundy (France), EDs and medical nursing homes (MNHs).
  
  
  
  1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013.
  
  
  
  For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED.
  
  
  
  Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs.
  
  
  
  In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs.
authors.affiliation: "Pôle de Gérontologie Interrégional (PGI) Bourgogne-Franche Comté", Besançon, France; Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy Franche Comté, Dijon, France. Electronic address: patrick.manckoundia@chu-dijon.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Manckoundia
authors.affiliation: "Pôle de Gérontologie Interrégional (PGI) Bourgogne-Franche Comté", Besançon, France; "Mutualité Sociale Agricole" of Burgundy, Dijon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Menu
authors.affiliation: Regional Emergency Department, François Mitterand Hospital, University Hospital, Dijon, France.
authors.forename: Alin
authors.initials: A
authors.lastname: Turcu
authors.affiliation: Regional Emergency Department, François Mitterand Hospital, University Hospital, Dijon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Honnart
authors.affiliation: Department of Geriatrics, Hospital Center, Sens, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rossignol
authors.affiliation: Medical Office, 9, rue Jean Sans Peur, Dijon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Alixant
authors.affiliation: Medical Office, 10A Place Saint-Jacques, Beaune, France.
authors.forename: Franck-Henry
authors.initials: FH
authors.lastname: Sylvestre
authors.affiliation: "Pôle de Gérontologie Interrégional (PGI) Bourgogne-Franche Comté", Besançon, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bailly
authors.affiliation: Faculty of Human Sciences, Department of Sociology, University of Burgundy Franche Comté, Dijon, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Dion
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Putot
mesh_terms: D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006300:Health Services Misuse / Q000639:trends*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission / Q000639:trends*; D011446:Prospective Studies
keywords: Elderly; emergency department; inappropriate admission; medical nursing home