Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy.
OBJECTIVES
To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions.


DESIGN
Prospective multicenter study.


SETTING
Burgundy (France), EDs and medical nursing homes (MNHs).


PARTICIPANTS
1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013.


MEASUREMENTS
For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED.


RESULTS
Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs.


CONCLUSION
In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs.
['Manckoundia|Patrick|P|', 'Menu|Didier|D|', 'Turcu|Alin|A|', 'Honnart|Didier|D|', 'Rossignol|Sylvie|S|', 'Alixant|Jean-Christophe|JC|', 'Sylvestre|Franck-Henry|FH|', 'Bailly|Vanessa|V|', 'Dion|Michèle|M|', 'Putot|Alain|A|']
D000369:Aged, 80 and over D004636:Emergency Service, Hospital D005260:Female D005602:France D006300:Health Services Misuse D006801:Humans D008297:Male D009735:Nursing Homes D010343:Patient Admission D011446:Prospective Studies
inappropriate admission medical nursing home emergency department Elderly