Nursing Home Patients and Emergency Department Attendance -Exploring Predictors of Hospital Admission

Abstract Background Older adults in nursing homes are frailer and are at high risk of emergency department (ED) attendance and adverse events in ED. While most referrals form nursing home are necessary, some may be preventable. We aimed to examine the attendances of nursing home patients to ED at our hospital and to explore for predictors of admission. Methods Data on patients from nursing home attending ED over a 6 month period (Sept 2024 to March 2025) was collated from our ED database. Multinomial regression was used to explore for predictors of hospital admission and inpatient length of stay of those admitted. Results 142 patients, mean age 78.4 years and 56.3% female. Half (51.4%) of referrals were very urgent and one third (35.9%) urgent. 59.9% were admitted to hospital and one died. More referrals to ED were on Sunday (19.0%) with the least on Thursday (9.1%). 48.7% were triaged between 9am to 5pm and 19.0% between midnight and 9am. In a subsample (where data available) the most common ED presentation (n=108) was falls (11.9%), chest pain (7.7%) and dyspnoea (7.7%). Independent predictors of hospital admission were triage category (P=0.01) and triage time (p=0.002) with no effect of gender, age, day or month of ED attendance. The median inpatient length of stay was 7.5 days (IQR 2.5-13.8) and was only independently predicted by severe triage category (p=0.036). Conclusion A high proportion of patients referred to ED were very urgent or urgent and 60% were admitted showing that most referrals were appropriate. As expected triage category predicted hospital admission. However, this was also predicted by triage time which deserves further exploration. A higher number of referrals on Sunday versus midweek may reflect less access to GP care at this time.