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Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care?

Authors
  • Lemoyne, Sabine E E1, 2
  • Van Bogaert, Peter3
  • Calle, Paul4
  • Wouters, Kristien2, 5
  • Deblick, Dennis2
  • Herbots, Hanne2
  • Monsieurs, Kg1, 2
  • 1 Emergency Department, Antwerp University Hospital, Edegem, Belgium. , (Belgium)
  • 2 Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium. , (Belgium)
  • 3 Centre for Research and Innovation in Care, University of Antwerp, Edegem, Belgium. , (Belgium)
  • 4 Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium. , (Belgium)
  • 5 Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium. , (Belgium)
Type
Published Article
Journal
Acta clinica Belgica
Publication Date
Feb 01, 2023
Volume
78
Issue
1
Pages
3–10
Identifiers
DOI: 10.1080/17843286.2022.2042644
PMID: 35234573
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The decision to transfer a nursing home (NH) resident to an emergency department (ED) is multifactorial and challenging but many of the emergency physician-staffed emergency medical service (EP-EMS) interventions and ED transfers are probably inappropriate. We conducted a retrospective, cross-sectional study in three EP-EMSs in Belgium over a period of three years. We registered indicators that are potentially associated with inappropriate transfers: patient characteristics, availability of written do not resuscitate (DNR) orders or treatment restrictions, involvement of a general practitioner (GP) and availability of transfer notes. We also explored the association between age, the Charlson Comordity Index (CCI), polypharmacy, dementia, and the availability of DNR documents. We registered 308 EP-EMS interventions in NH residents. In 98% the caller was a health-care professional. In 75% there was no GP present and 40% had no transfer note. Thirty-two percentage of the patients had dementia, 45% had more than two comorbidities and 68% took five medications or more. In 6% cardiopulmonary resuscitation was performed. DNR orders were available in 25%. Eighty-eight percentage of the NH residents were transferred to the ED. Forty-four percent had a CCI >5. In patients of ≥90 years, with a CCI >5, with dementia and with polypharmacy, DNR orders were not available in 81%, 67%%,and 69%, respectively. Improved EMS dispatch centre-NH caller interaction, more involvement of GP's, higher availability of DNR orders and better communication between GPs/NHs and EP-EMS could prevent inappropriate interventions, futile prehospital aactions,and ED transfers.

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