[The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home]

. The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home.

Many Emergency Departments (ED) transfers of Nursing Home (NH) residents are potentially avoidable or even inappropriate since problems could be prevented or managed in the NH.

To describe characteristics and outcomes of NH residents transferred to ED for respiratory, cardiovascular and neurological problems and symptoms of infection.

A retrospective descriptive study using clinical records data from 2013-2016 of a NH was conducted.

In 4 years (2013-2016), 143 ED accesses occurred, 55 (38.6%) for medical problems in 48 residents. The residents were mainly women, with advanced age. Forty-two/55 accesses (76.4%) resulted in an hospital admission and 16 residents (38.1%) died in hospital; of the 13 discharged, 3 died the NH after a few days. The most frequent reason for hospitalization was an infection (22): respiratory (18), urinary (2) or both (2). The week before ED admission 1/3 of residents was asymptomatic, 1/3 had only one typical symptom accompained by drowsiness or agitation (7), gastrointestinal problems (5), or other non-specific symptoms. On ED admission prevalent signs and symptoms were desaturation (13), dyspnea (10) and fever (9). Six/22 residents had started an antibiotic treatment in the NH.

Proactive management policies need to be promoted for residents with infections, based on explicit criteria to promptly monitor changes in clinical conditions and on the education educate professionals to suspect an infection even with non-specific symptoms.