ED Visits By Nursing Home Residents 'Disproportionately High'

Cheryl Clark, for HealthLeaders Media , October 30, 2013

An emergency medicine physician and researcher suggests that skilled nursing facility residents with "ambulatory care-sensitive conditions" may be treated appropriately in healthcare settings other than the emergency department.

"Going to the emergency department can actually be somewhat traumatic" for a nursing home patient, says Renee Hsia, MD, an emergency department physician at the University of California San Francisco Department of Emergency Medicine.

Yet nearly one in five patients taken to a hospital emergency department from a skilled nursing facility are treated for so-called "ambulatory care-sensitive conditions," suggesting that some of their medical issues might be more effectively managed by the SNF's healthcare team, or in another less intense setting.

Hsia and colleagues from the UCSF Department of Emergency Medicine, analyzed annual National Hospital Ambulatory Medical Care Survey data from 2001 to 2010 whose Research Letter published Monday in JAMA Internal Medicine.

See Also: 5 Ways Health Systems Can Reduce ED Usage

She describes what it's like for these sick, elderly patients. "They're waiting a long time, sometimes in the hallway with a lot of commotion, and it's definitely not a comfortable environment. And these are patients who are going to be sensitive to different environment, in terms of delirium."

If a visit to the ED can be avoided, she says, it should be.

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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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