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

Abstract

Background/Objectives: 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. Design: 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. Participants: 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. Results: 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]. Conclusion: 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: NCT01703689.