Nursing home residents with cognitive impairment and/or respiratory distress are the most likely to be admitted to the hospital after a trip to the emergency department, a new study has found. 

The researchers analyzed hundreds of transfers from the nursing facility to the emergency department. In contrast with the reasons linked to likelihood of hospital admission, the factors most associated with discharge back to the nursing home were falls, trauma or fracture, non-gastrointestinal bleeding, and pain.

Approximately one quarter of nursing home residents experience transfer to the hospital within a year. What’s more, admission to the emergency department and/or hospital are known to be associated with long-term health effects in this population, the investigators said. 

“Transfers of care can be very difficult on the patient. Our goal in analyzing this data is to identify new opportunities to improve care, whether it’s preventing transfers to the emergency department or finding ways to avoid hospital admissions,” said lead author Kathleen Unroe, M.D., MHA, from Regenstrief Institute and Indiana University School of Medicine.

Better understanding of who is likely to receive emergency department care could prompt adoption of targeted resources and protocols, potentially focused on falls or symptom management, Unroe and colleagues wrote.

The authors suggest implementation of strategies to ensure that emergency department providers have high-quality information when residents are assessed, as well as an understanding of the capabilities of the transferring nursing facility to manage acutely ill and symptomatic residents. Providers must be confident in the hand-off back to a facility, they concluded.

The study was published in the Journal of the American Geriatrics Society.