Impact of acute geriatric services for nursing home residents on emergency department presentation and hospitalisation

Abstract

Background. Prior to May 2015, our hospital provided only non-urgent geriatric services for nursing home residents. Thereafter, the Connecting Care Programme was introduced to provide acute geriatric services, including administration of intravenous antibiotics and fluids and a variety of other procedures. This audit aimed to investigate the impact of acute geriatric services for nursing home residents on emergency department presentation and hospitalisation. Methods. Medical records of nursing home residents who presented to the Bankstown-Lidcombe Hospital before (from May to August 2014) and after (from May to August 2015) the Connecting Care Programme were retrospectively reviewed. The two groups were compared in terms of emergency department presentation and discharge rates. Results. Respectively for the group before and after the programme, of all presentations to the emergency department, 276 and 318 involved nursing home residents (6.1% vs 7.1%, p=0.056). Of these, 106 and 167 were discharged from the emergency department (38.4% vs 52.5%, odds ratio=1.76, 95% confidence interval=1.2-2.4, p=0.0008). The Connecting Care Programme increased the discharge rate in those with a diagnosis of fall without fracture (70% vs 88%, p=0.021), respiratory (11% vs 31%, p=0.020), gastrointestinal (34% vs 50%, p=0.025), or cardiovascular (24% vs 60%, p=0.010) complaints. Conclusion. The Connecting Care Programme resulted in an increased discharge rate and decreased hospital admission rate for nursing home residents who presented with fall without fracture, respiratory, gastrointestinal, or cardiovascular complaints. The programme may enable better utilisation of healthcare resources.