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RESEARCH PRODUCT
Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy
Didier HonnartJean-christophe AlixantSylvie RossignolAlain PutotMichele DionDidier MenuAlin TurcuPatrick ManckoundiaFranck-henry SylvestreVanessa Baillysubject
Malemedicine.medical_specialtyemergency department[ SDV.MHEP.GEG ] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontologyHealth Services MisuseExpert committee03 medical and health sciencesPatient Admission0302 clinical medicineElderlymedicineHumansProspective Studies030212 general & internal medicineProspective cohort studyGeneral NursingAged 80 and overHealth professionalsbusiness.industryHealth Policy[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontologyinappropriate admissionMean ageGeneral MedicineEmergency departmentmedical nursing homeNursing HomesMulticenter studyEmergency medicineFemaleFranceGeriatrics and GerontologyEmergency Service HospitalNursing homesbusiness030217 neurology & neurosurgerydescription
Abstract Objectives To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Design Prospective multicenter study. Setting Burgundy (France), EDs and medical nursing homes (MNHs). Participants 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. Measurements 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. Results 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. Conclusion 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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2016-07-01 |