title: Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia.
abstract: BACKGROUND
  Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program.
  
  
  METHODS
  RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.
  
  
  RESULTS
  In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007].
  
  
  CONCLUSIONS
  The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia.
authors.forename: Bill
authors.initials: B
authors.lastname: Lukin
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Fan
authors.affiliation: Bureau of Investment Promotion, Wuwei City 733000, Gansu Province, China.
authors.forename: Jing-Zhou
authors.initials: JZ
authors.lastname: Zhao
authors.affiliation: Queensland Health, Brisbane, Queensland 4029, Australia.
authors.forename: Jian-Dong
authors.initials: JD
authors.lastname: Sun
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
authors.forename: Kaeleen
authors.initials: K
authors.lastname: Dingle
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Purtill
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4006, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Tapp
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Hou
keywords: Emergency department; Presenting complaint; Residential aged care