Avoidable emergency department admissions among nursing home residents - insights from a retrospective study

The number of nursing home residents (NHRs) admitted to emergency departments (EDs) is steadily increasing. Some of these admissions have been identified as potentially avoidable. This study aims to quantify avoidable admissions at a Belgian hospital and identify factors associated with these admissions. A retrospective assessment tool is also proposed for the rapid identification of avoidable admissions.

One-year retrospective descriptive study of NHR admissions to the ED of a Belgian university hospital. The avoidability of each admission was assessed using a retrospective assessment tool and independently assessed by two geriatricians based on clinical judgment. The sensitivity and specificity of the tool were measured against clinical judgment as the reference standard.

A total of 246 NHRs visited the ED, accounting for 327 admissions. Based on clinical judgment, 22.6% of admissions were deemed potentially avoidable. Direct costs were estimated. The retrospective assessment tool identified a rate of 14.1% (specificity: 98.4% and sensitivity: 56.8%). The most common presenting complaints for avoidable admissions were falls (26.1%), minor catheter-related issues (13.5%), and wounds (8.1%). No significant differences were observed in population and NH characteristics between avoidable and non-avoidable admissions.

We identified approximately one in five ED admissions among NHRs as potentially avoidable. This work also presents a specific tool enabling identification and quantification of avoidable admissions. Detecting the most common "avoidable" presenting complaints and diagnoses associated with avoidable admissions presents potential opportunities to explore alternative care solutions within nursing homes.