Glenn Arendts1, Kirsten Howard. 1. Emergency Medicine, Centre for Clinical Research in Emergency Medicine, Western Australian Centre for Medical Research, Royal Perth Hospital, University of Western Australia. glenn.arendts@uwa.edu.au
Abstract
BACKGROUND: emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known. DESIGN: systematic review based on a comprehensive literature search in three electronic databases and published article reference lists. RESULTS: the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care. CONCLUSIONS: residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.
BACKGROUND: emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known. DESIGN: systematic review based on a comprehensive literature search in three electronic databases and published article reference lists. RESULTS: the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care. CONCLUSIONS: residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.
Authors: Carolyn Hullick; Christopher R Carpenter; Robert Critchlow; Ellen Burkett; Glenn Arendts; Guruprasad Nagaraj; Tony Rosen Journal: Emerg Med Australas Date: 2017-03-08 Impact factor: 2.151
Authors: Christine E Mc Carthy; Tracy Keating; Vinny Ramiah; Dermot Power; Joseph Duggan; Chie Wei Fan Journal: Ir J Med Sci Date: 2020-05-29 Impact factor: 1.568