European Geriatric Medicine

, Volume 9, Issue 3, pp 339–346 | Cite as

Organizational and environmental factors associated with transfers of nursing home residents to emergency departments

  • Xavier DubucsEmail author
  • Philipe de Souto Barreto
  • Yves Rolland
Research Paper



The emergency department transfer (EDT) rate of residents from nursing homes (NHs) to emergency departments is an important public health issue. The purpose of this study was to examine whether organizational and geographical factors were associated with EDT among older adults living in NHs.


Retrospective analysis using information from patients’ medical charts regarding hospitalization in the last 12 months. Information came from the baseline data of the IQUARE clinical trial.


5926 residents (86.0 years old, standard deviation, SD = 2.9), from 175 NHs with available data on EDT.

Outcome measure

The EDT rate was estimated for each NH, from the number of residents who were transferred to an emergency department (one transfer or more) in the previous 12 months.


1119 (18.9%, SD = 11.5) residents were transferred to an emergency department at least once during the past year. In adjusted multiple linear regression, NHs located in rural areas had an EDT rate significantly lower than those in urban areas (confidence interval, 95% CI − 10.15, − 2.16, p = 0.003), with an absolute EDT rate of 16.4% (SD = 9.1) versus 20.4% (SD = 12.5); pharmacy for internal use was significantly associated with a lower EDT rate compared with the NHs with no PUI [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI − 16.33, − 3.09, p = 0.004] and the implementation of a personalized care project in NHs was significantly associated with a lower EDT rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI − 11.67, − 0.63, p = 0.03].


Our study suggests that a structured plan of care, a strategy to improve medication and being located in rural areas reduce the EDT rate in NH residents.

IQUARE study trial registration number



Nursing homes Emergency department Hospitalization Environmental Elderly Pharmacy 



Coordinating physician


Coordinating nurse


Emergency department


Emergency Department transfer (per year)


Weighted average GIR


General Practitioner

95% CI

95% confidence interval


National Institute of Statistics and Economic Studies


“l’Impact d’une démarche Qualité sur l’évolution des pratiques et le déclin fonctionnel des Résidents” (Impact of a Quality approach on the development of practices and the functional decline of residents)


Nursing Home


Pharmacy for internal use


Author contributions

XD, PSB and YR conceived the study and designed the statistical analyze. PSB and YR provided statistical advice on study design. XD leads the statistical analyze and drafted the manuscript. All authors contributed substantially to its revision. XD takes responsibility for the paper as a whole.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical approval

The research protocol complied with the principles of the Declaration of Helsinki and was approved by the ethics committee of Toulouse University Hospital and the Consultative Committee for Treatment of Research Information on Health (CNIL: 07-438).

Informed consent

For this type of study formal consent is not required.


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Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Gérontopôle, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)ToulouseFrance
  2. 2.UMR INSERM 1027, University of Toulouse IIIToulouseFrance

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