Sie befinden Sich nicht im Netzwerk der Universität Paderborn. Der Zugriff auf elektronische Ressourcen ist gegebenenfalls nur via VPN oder Shibboleth (DFN-AAI) möglich. mehr Informationen...
Factors associated with Emergency Medical Dispatcher request and residents’ inappropriate transfers from Nursing Homes to Emergency Department
Ist Teil von
European geriatric medicine, 2022-04, Vol.13 (2), p.351-357
Ort / Verlag
Cham: Springer International Publishing
Erscheinungsjahr
2022
Link zum Volltext
Quelle
SpringerLink (Online service)
Beschreibungen/Notizen
Key summary points
Aim
We aimed to identify factors associated with potentially inappropriate resident transfers from the nursing home to emergency department requested by an emergency medical dispatcher.
Findings
Onsite medical examination before transfer and prompt available psychiatric advice was associated with a low rate whereas the presence of a Special Care Unit in Nursing was associated with a high rate of potentially inappropriate transfer.
Message
Promoting onsite examination and partnership thanks to available geriatrician’s advice may help the emergency medical dispatcher to improve the appropriateness of residents’ transfer from the nursing home to the emergency department.
Purpose
In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request.
Methods
This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team.
Results
Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD’s decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07–2.93];
p
= 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33–0.83];
p
= 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33–0.84];
p
= 0.007) were associated with a low rate of potentially inappropriate transfer.
Conclusion
Promoting onsite medical assessment and partnership thanks to available geriatrician’s advice may help the emergency medical dispatcher to improve the appropriateness of residents’ transfer from Nursing Home to the emergency department.