Evaluating acuity of pre-conveyance referrals from nursing homes

<bold>Background:</bold> Limited out-of-hours primary care services led to increased conveyances of nursing home residents to the emergency department. We studied the pattern and acuity pre-conveyance consultations from the nursing homes with emergency department senior doctors. <bold>Methods:</bold> 337 out-of-hours pre-conveyance consultation forms from nursing homes to an acute hospital reviewed from April 2020 to February 2022. <bold>Results:</bold> Residents with NEWS Aggregate above 5 were more likely to be conveyed to the emergency department (Odds Ratio 4.1; 95% CI: 2.11,7.88). When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p<.001), oxygen saturation (p<.001), and the use of oxygen supplementation (p<.005). Decision for ambulance conveyance is not significantly associated with heart rate (p=.89), temperature (p=.90), systolic blood pressure (p=1.00). <bold>Conclusions:</bold> Decision to convey an acutely ill resident to the emergency department concurred with the NEWS aggregate. Respiratory rate, oxygen saturation, and use of supplementary oxygen were more discriminative in predicting the need for transfer of resident to emergency department than the other parameters. The above components should be incorporated in algorithm of machine learning in the development of out-of-hours chatbot as computerized decision support system.