Journal Article

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

Remmen, Roy, Lemoyne, Sabine E, Herbots, Hanne H., Van Bogaert, Peter, Monsieurs, Koenraad G., De Blick, Dennis

2019

Overview

Background Elderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable. Methods Systematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract. Results Seventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital. Conclusions The definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Advance Directives / Aged / Aged, 80 and over / Aging / Ambulatory care / Appropriateness / Autonomy / Beliefs, opinions and attitudes / Care and treatment / Chronic illnesses / Clinical decision making / Collaboration / Decision making / Delivery of Health Care - methods / Delivery of Health Care - standards / Demographic aspects / Elder care / Emergency department / Emergency medical care / Emergency medical service / Emergency medical services / Emergency medicine / Emergency Service, Hospital - standards / Evaluation / Evidence-based medicine / Family physicians / Frailty / General practitioner / General practitioners / Geriatric research / Geriatrics / Geriatrics/Gerontology / Health aspects / Health services research / Hospital admission and discharge / Hospital emergency services / Hospitalization / Humans / Medical law / Medicine / Medicine & Public Health / Mortality / Nursing care / Nursing home / Nursing home patients / Nursing homes / Nursing Homes - standards / Nursing staff / Nursing Staff - standards / Older people / Online databases / Patient transfer / Patient Transfer - methods / Patient Transfer - standards / Qualitative Research / Rehabilitation / Research Article / Systematic review / Telemedicine / Trauma