P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

Content Provider	Scilit
Author	Losier, E. McCollum, A. Jarrett, P. McCloskey, R. Nicholson, P. Howlett, M.
Copyright Year	2016
Abstract	Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.
Related Links	https://www.cambridge.org/core/services/aop-cambridge-core/content/view/B8CDFC5B999ABEA08395F5B73C81B520/S1481803516002591a.pdf/div-class-title-p083-why-do-older-adults-in-assisted-living-facilities-use-the-emergency-department-are-all-these-visits-necessary-div.pdf
Ending Page	S106
Page Count	1
Starting Page	S106
DOI	10.1017/cem.2016.259
Journal	Canadian Journal of Emergency Medicine
Issue Number	S1
Volume Number	18
Language	English
Publisher	Cambridge University Press (CUP)
Publisher Date	2016-05-01
Access Restriction	Open
Subject Keyword	Canadian Journal of Emergency Medicine Respiratory System Assisted Living Emergency Visit
Content Type	Text
Resource Type	Synopsis