Emergency department visits by nursing home residents: analysis of routine data from an urban hospital

Abstract

Background: The number of emergency department (ED) visits in Germany continues to increase, especially by older people and persons receiving care. Objectives: We aimed to characterize ED visits by nursing home residents (NHR) in Germany. Materials and methods: We analyzed routine data of a hospital without trauma surgery (Pius-Hospital Oldenburg). All ED visits by NHR in the period 06/2014–05/2017 were selected from the hospital information system. Results: Of 47,270 ED visits, 1676 (3.6%) were NHR (mean age: 78.8 years; 62.9% women; 40.3% were referred). Of them, 20.1% were on weekends and 80.6% occurred between 8 am–8 pm. A total of 84.2% visits led to hospitalization; the length of stay was 1 day for 21.1% and 2–3 days for another 14.6%. With longer length of stay, the proportion of admissions by referring physicians increased. Of those admitted, 10.3% died during hospitalization (28.2% on the day of admission; 47.9% within the first 3 days). People who died were older, their visits were more frequently on weekends, and they were less often referred. Conclusion: Our study reveals problems in several areas. Improved interprofessional cooperation with general practitioners and strengthened palliative structures should be implemented in nursing homes. Furthermore, there is a need for establishing processes in EDs to realize continued outpatient care for these patients.