Skip to main content
SpringerLink
Log in

Nursing home patients and Emergency Department attendance in a single urban Irish catchment area: an observational study surrounding the introduction of a community medicine for older person service

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Nursing home (NH) patients are at a high risk of Emergency Department (ED) attendance, and adverse events in the ED. With an increasing NH population, monitoring trends in ED utilization is important to aid service planning, and attention to potentially preventable attendances should be paid, to identify areas that may benefit from specialist support.

Aims

This 12-year (2008–2019) study aimed to observe trends in ED utilization of NH patients in a single urban Irish catchment area, surrounding the introduction of a Community Medicine for the Older Person (CMOP) outreach program.

Method

A retrospective review of all NH attendances within the catchment area was performed based upon NH address. Attendance, admission, discharge, and died in department (DID) were adjusted per annual NH bed numbers (PBC). Trends were observed and compared pre and post the CMOP activation. Comparisons of continuous variables were performed using an unpaired parametric Student’s t test.

Results

There were 6877 attendances, with 58% (n = 3989) admitted, 40% (n = 2785) discharged, and 2% (n = 123) DID. There was a statistically significant difference in mean discharge rate PBC pre and post the CMOP introduction (0.22 vs 0.16, P = 0.04). There was no statistically significant difference in attendance, admission, or DID.

Conclusion

This is the first Irish study of NH ED utilization over an extended period. ED attendances PBC have not decreased since the introduction of the CMOP. Discharges PBC, however, have decreased and may represent a decrease in potentially preventable attendance/improvement in appropriateness of ED transfers, following the introduction of this intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Falconer M, O’Neill D (2007) Profiling disability within nursing homes: a census-based approach. Age Ageing 36(2):209–213. https://doi.org/10.1093/ageing/afl185

    Article  PubMed  Google Scholar 

  2. Onder G, Liperoti R, Fialova D et al (2012) Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67A(6):698–704. https://doi.org/10.1093/gerona/glr233

    Article  Google Scholar 

  3. Hubbard RE, O’Mahony MS, Woodhouse KW (2008) Characterising frailty in the clinical setting--a comparison of different approaches. Age Ageing 38(1):115–119. https://doi.org/10.1093/ageing/afn252

    Article  PubMed  Google Scholar 

  4. Crilly J, Chaboyer W, Wallis M, Thalib L, Green D (2008) Predictive outcomes for older people who present to the emergency department. Australas Emerg Nurs J 11(4):178–183. https://doi.org/10.1016/j.aenj.2008.07.002

    Article  Google Scholar 

  5. Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J (2014) A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 43(6):759–766. https://doi.org/10.1093/ageing/afu117

    Article  PubMed  Google Scholar 

  6. O’Sullivan R, Murphy A, O’Caoimh R, Cornally N, Svendrovski A, Daly B, Fizgerald C, Twomey C, McGlade C, Molloy DW (2016) Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes. BMC Res Notes 9(1):237. https://doi.org/10.1186/s13104-016-2048-9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Grabowski DC, O’Malley AJ, Barhydt NR (2007) The costs and potential savings associated with nursing home hospitalizations. Health Aff (Millwood) 26(6):1753–1761. https://doi.org/10.1377/hlthaff.26.6.1753

    Article  Google Scholar 

  8. Briggs R, Coughlan T, Collins R, O’Neill D, Kennelly SP (2013) Nursing home residents attending the emergency department: clinical characteristics and outcomes. QJM. 106(9):803–808. https://doi.org/10.1093/qjmed/hct136

    Article  CAS  PubMed  Google Scholar 

  9. Nursing Homes Ireland Private & Voluntary Nursing Home Survey 2014/2015. BDO

  10. Anderson GF, Hussey PS (2000) Population aging: a comparison among industrialized countries: populations around the world are growing older, but the trends are not cause for despair. Health Aff (Millwood) 19(3):191–203. https://doi.org/10.1377/hlthaff.19.3.191

    Article  CAS  Google Scholar 

  11. Department of Health / PA Consulting: Health Service Capacity Review 2018: Review of Health Demand and Capacity Requirements in Ireland to 2031 (2018)

  12. Gruneir A, Bell CM, Bronskill SE, Schull M, Anderson GM, Rochon PA (2010) Frequency and pattern of emergency department visits by long-term care residents-a population-based study: ED VISITS BY LONG-TERM CARE RESIDENTS. J Am Geriatr Soc 58(3):510–517. https://doi.org/10.1111/j.1532-5415.2010.02736.x

    Article  PubMed  Google Scholar 

  13. Ouslander JG, Lamb G, Tappen R, Herndon L, Diaz S, Roos BA, Grabowski DC, Bonner A (2011) Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project: interventions to reduce hospitalizations from nursing homes. J Am Geriatr Soc 59(4):745–753. https://doi.org/10.1111/j.1532-5415.2011.03333.x

    Article  PubMed  Google Scholar 

  14. Ouslander JG, Bonner A, Herndon L, Shutes J (2014) The interventions to reduce acute care transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care. J Am Med Dir Assoc 15(3):162–170. https://doi.org/10.1016/j.jamda.2013.12.005

    Article  PubMed  PubMed Central  Google Scholar 

  15. Unroe KT, Nazir A, Holtz LR, Maurer H, Miller E, Hickman SE, la Mantia MA, Bennett M, Arling G, Sachs GA (2015) The optimizing patient transfers, impacting medical quality, and improving symptoms: transforming institutional care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project. J Am Geriatr Soc 63(1):165–169. https://doi.org/10.1111/jgs.13141

    Article  PubMed  Google Scholar 

  16. Hullick C, Conway J, Higgins I, Hewitt J, Dilworth S, Holliday E, Attia J (2016) Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study. BMC Geriatr 16(1):102. https://doi.org/10.1186/s12877-016-0279-1

    Article  PubMed  PubMed Central  Google Scholar 

  17. Caplan GA, Meller A, Squires B, Chan S, Willett W (2006) Advance care planning and hospital in the nursing home. Age Ageing 35(6):581–585. https://doi.org/10.1093/ageing/afl063

    Article  PubMed  Google Scholar 

  18. Montalto M, Chu MY, Ratnam I, Spelman T, Thursky K (2015) The treatment of nursing home-acquired pneumonia using a medically intensive hospital in the home service. Med J Aust 203(11):441–442. https://doi.org/10.5694/mja15.00672

    Article  PubMed  Google Scholar 

  19. Arendts G, Howard K (2010) The interface between residential aged care and the emergency department: a systematic review. Age Ageing 39(3):306–312. https://doi.org/10.1093/ageing/afq008

    Article  PubMed  Google Scholar 

  20. Report of the National Acute Medicine by the Royal College of Physicians Ireland, The Irish Association of the Directors of Nursing and Midwifery, Therapy Professions Committee, Quality and Clinical Care Directorate, Health Service Executive, 2010

  21. Fan CW, Keating T, Brazil E, Power D, Duggan J (1971- 2016) Impact of season, weekends and bank holidays on emergency department transfers of nursing home residents. Ir J Med Sci 185(3):655–661. https://doi.org/10.1007/s11845-015-1332-3

    Article  Google Scholar 

  22. Vossius CE, Ydstebø AE, Testad I, Lurås H (2013) Referrals from nursing home to hospital: reasons, appropriateness and costs. Scand J Public Health 41(4):366–373. https://doi.org/10.1177/1403494813484398

    Article  PubMed  Google Scholar 

  23. Kirsebom M, Hedström M, Wadensten B, Pöder U (2014) The frequency of and reasons for acute hospital transfers of older nursing home residents. Arch Gerontol Geriatr 58(1):115–120. https://doi.org/10.1016/j.archger.2013.08.002

    Article  PubMed  Google Scholar 

  24. Kirsebom M, Hedström M, Pöder U, Wadensten B (2017) Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates. Nurs Open 4(1):41–48. https://doi.org/10.1002/nop2.68

    Article  PubMed  Google Scholar 

  25. Murphy K, Cooney A, Casey D (2014) Improving the quality of life for older people in long-term care settings. J Comp Eff Res 3(3):301–315. https://doi.org/10.2217/cer.14.20

    Article  PubMed  Google Scholar 

  26. McCarthy-Haslam G, Tyrrell MP, Cronin C (2002) Ireland, Department of Health and Children. National Study of Turnover in Nursing and Midwifery. Dept. of Health and Children, Dublin

    Google Scholar 

  27. Central Statistics Office. Census of Population (2016) Profile 3, An Age Profile of Ireland. http://www.Cso.Ie/En/Csolatestnews/Presspages/2017/Census2016profile3-Anageprofileofireland/

  28. Warren C, Tom B, Sinead H-E et al (2018) What Are the Main Reasons for Hospital Admissions in Nursing Home Patients? J Geriatr Med Gerontol 4(1). https://doi.org/10.23937/2469-5858/1510039

Download references

Author information

Authors and Affiliations

  1. National University of Ireland, Galway, Ireland

    Christine E. Mc Carthy

  2. Mater Misericordiae University Hospital, Dublin, Ireland

    Christine E. Mc Carthy, Tracy Keating, Vinny Ramiah, Dermot Power, Joseph Duggan & Chie Wei Fan

  3. University College Dublin, Dublin, Ireland

    Dermot Power, Joseph Duggan & Chie Wei Fan

Authors
  1. Christine E. Mc Carthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracy Keating
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vinny Ramiah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dermot Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph Duggan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chie Wei Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine E. Mc Carthy.

Ethics declarations

Conflicts of interest

Some authors work as part of or in conjunction with the CMOP or the MMUH ED department, but do not declare any competing interests.

Ethics approval

This study looked at NH address, and outcome based on address, within our catchment area only, and no identifying patient data was accessed or collected. This was ensured by the senior author and data controller. Given that this study involved NH address only did not involve individual participants or access to individual data, ethical approval was not deemed necessary.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mc Carthy, C.E., Keating, T., Ramiah, V. et al. Nursing home patients and Emergency Department attendance in a single urban Irish catchment area: an observational study surrounding the introduction of a community medicine for older person service. Ir J Med Sci 190, 379–385 (2021). https://doi.org/10.1007/s11845-020-02267-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02267-7

Keywords

Search

Navigation