Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy

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• 作者：Patrick Manckoundia ; MD ; PhD^a ; ^b ; ^c ; ^{patrick.manckoundia@chu-dijon.fr" class="auth_mail" title="E-mail the corresponding author} ; Didier Menu ; MD^a ; ^d ; Alin Turcu ; MD^e ; Didier Honnart ; MD^e ; Sylvie Rossignol ; MD^f ; Jean-Christophe Alixant ; MD^g ; Franck-Henry Sylvestre ; MD^h ; Vanessa Bailly ; MA^a ; Michè ; le Dion ; PhDⁱ ; Alain Putot ; MD^b
• 关键词：Elderly ; emergency department ; inappropriate admission ; medical nursing home
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 July 2016
• 年：2016
• 卷：17
• 期：7
• 页码：671.e1-671.e7
• 全文大小：244 K

文摘

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.