Nursing home resident deaths in a tertiary care hospital

To investigate why residents of residential aged care homes (RACH) are transferred to hospital for end-of-life care (EoLC).

We audited electronic health records at one tertiary referral centre hospital (New South Wales, Australia) from 1 June 2021 to 30 May 2023.

Over a 2 year period, there were 2535 presentations to the emergency department (ED) from RACH, of which 45% were transferred back to RACH, 9% died in ED and 46% were admitted to hospital. Only 17% of those admitted were referred to palliative care, with an average delay of 3 days. The most common reasons for admission were falls, shortness of breath and sepsis. Most patients were in extremis at the time of referral, with an average time to death of 3 days; this was the most common barrier to returning patients to RACH (48%). In other cases (30%), the desired place of care was hospital or there was an urgent reason for admission, for example, fracture requiring surgery.

Once RACH patients are admitted to hospital for EoLC, there is little time to influence the trajectory of care. Future efforts should focus on supporting care in RACH and providing EoLC in situ.