ED Visits By Nursing Home Residents 'Disproportionately High'

Cheryl Clark, for HealthLeaders Media , October 30, 2013

Hsia emphasizes that her report does not say that all patients brought to a hospital emergency department for ambulatory care-sensitive conditions don't need to be. Clearly some of them require that transfer.

"But maybe if you had other resources, or in a nursing home environment if there were other incentives available to treat the patient in that setting, they may not need to come to the ED."

"What we're asking is, 'Is there a significant portion of these nursing home patients who come to the ED because of conditions that might be treated in a nursing home?'" After all, skilled nursing homes have healthcare workers on staff, "and nursing homes tend to have relationships with physicians as well; There should be someone to at least call who is readily available for that."

"We need to ask, where is the best place that we can provide the care they need, and how do we get the most appropriate resources to the right patient at the right time?" Hsia asks. "Is it the ED, or should we provide more resources or create the right incentives so these people can be treated appropriately in an alternative setting?"

One finding from the study is that the percentage of nursing home patients transported to a hospital emergency department rose in that 10-year period by 12.8%, from 1.9 million patients in 2001 to 2.1 million in 2010.

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2 comments on "ED Visits By Nursing Home Residents 'Disproportionately High'"

M. Bennet Broner, PhD (10/30/2013 at 12:14 PM)
Years ago, I performed quality assessments of nursing home care for Medicaid and I was surprised at the frequency with which residents were transported to the ED though their conditions could likely have been treated "in-house". Transportation, often by ambulance, occurred for not only suspected UTIs, but also for a minimal spike in temperature, and even for ear wax removal. These facilities had medical directors and many of the patients had personal physicians listed on their charts. Could these professionals not have been consulted first or could they have visited the patient at the home rather than their being transported to overburdened EDs?

Deb Collier (10/30/2013 at 10:08 AM)
SNF medical care is fragmented and limited by the episodic medical oversight provided by the team of medical providers which may change daily. They are not staffed to deliver preventative care through continuous monitoring of chronic conditions. Even when we bring issues to their attention, they are passive and when challenged, call an ambulance. Basic proactive measures are not standard such as a urine dip after treatment for a UTI or removal of a catheter. Is that because CMS does not pay or authorize? It takes over 24 hours to implement any medication or treatment change and then the subsequent aides and nurses do not always follow orders (daily weight - pressure stockings - hydration)because they are short staffed and pressured to care for numerous "guests" simultaneously. Two hospitalizations in three weeks is costly in many terms but of most importance to us, it delays rehab and reduces the chances of any level of recovery. Keep researching this topic. We can do better for our parents and loved ones.




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