Evaluating Acute Care Alternatives for Nursing Home Residents

Abstract Background Nursing home residents (NHRs) represent the frailest group of healthcare service users with highly complex care needs. It is well accepted that high rates of emergency department (ED) attendances and hospital admissions are common among this group. Ambulatory, community based unscheduled care should be explored as alternative pathways that could provide safe and quality care for NHRs. Methods This retrospective study examined NHRs admitted between June and December 2024, to a University Teaching Hospital. Data on diagnoses, length of stay and readmission rates collected. Results A total of 312 NHRs presented to the ED over the 6 month period. Rate of admission was 63.8% (n=199). Of these, 68.3% (n=136) admitted under the geriatric service. Close to 30% (n=59) of admitted NHRs were discharged within 48 hours. One month re-admission rate of this group was 10.1% (n=6) .The three most common discharge diagnoses were lower respiratory tract infection (n=15), aspiration pneumonia (n=11), and falls (n=10). 16.5% NHR admissions (n=33) occurred outside of normal working hours. Conclusion This study highlights the high admission rate of NHRs, particularly when ED presentations occurred outside of normal working hours. Almost 1 in 3 of admitted NHRs had hospital length of stay of ≤ 48 hours, without higher re-admission rates. The potential of ambulatory care pathways including outreach services to nursing homes to reduce hospital admissions and to avoid associated iatrogenic complications, should be further explored.