Emergency Medicine Department, CHRU Tours, Tours, France.
Emergency Medicine Department, CHRU Tours, Tours, France; University of Tours, School of Medicine, Tours, France.
Int Emerg Nurs. 2023 Jul;69:101312. doi: 10.1016/j.ienj.2023.101312. Epub 2023 Jun 20.
France is experiencing a steady increase in the number of residents living in nursing homes (NHs). Each year, 25% of these residents are hospitalized, half of them through emergency departments (EDs). A part of these transfers to EDs are unjustified and not without consequences. The first aim of our study is to evaluate the proportion of avoidable NHs resident transfer to EDs.
An observational, prospective and multicentric study was conducted between January and August 2019 in the 6 EDs of a French county during 3 inclusion periods. A multidisciplinary expert panel determined the appropriateness of each ED transfer. The results were expressed in gross values and %. Expert agreement was assessed by Fleiss' kappa statistical measure.
Transfers were deemed avoidable in 12 to 35% of cases and appropriate in 53 to 81% of cases according to the experts. Fleiss' Kappa score on the concordance of the different experts' answers concerning the relevance of transfers was slight with k = 0.28 with a significant p-value (p < 0.0001). Infection could benefit of direct hospitalization whereas trauma/wound and acute heart/pulmonary failure are the most relevant reasons of presentation to the ED.
Too many ED transfers of NH residents remain avoidable. There is a disparity of results among the experts reflecting a limitation of this study related to the subjective nature of relevance. In a society where demographic projections predict a continuing aging population anywhere EDs are regularly crowded, it would be interesting to identify and prevent factors predisposing to ED transfer and consider alternative managements with a better geriatric and emergency physicians collaboration for this specific population.
法国的养老院（NH）居民数量稳步增加。每年，这些居民中有 25%住院，其中一半是通过急诊部（ED）住院。这些转至 ED 的患者中，有一部分的转院是不合理的，且并非没有后果。我们研究的首要目的是评估可避免的 NH 居民转至 ED 的比例。
这是一项于 2019 年 1 月至 8 月在法国一个县的 6 个 ED 进行的观察性、前瞻性和多中心研究，包括 3 个纳入期。一个多学科专家小组确定了每个 ED 转院的适宜性。结果以总数值和百分比表示。专家意见的一致性通过 Fleiss'kappa 统计测量来评估。
根据专家意见，12%至 35%的转院是可避免的，53%至 81%的转院是适宜的。不同专家对转院相关性的回答一致性的 Fleiss'kappa 评分较差，k=0.28，p 值显著（p<0.0001）。感染患者可直接住院治疗，而创伤/伤口和急性心脏/肺部衰竭是最常见的 ED 就诊原因。
太多 NH 居民的 ED 转院仍然是可避免的。专家的结果存在差异，反映了这项研究的局限性，即相关性具有主观性。在一个人口统计学预测人口持续老龄化的社会中，任何地方的 ED 都经常人满为患，确定并预防导致 ED 转院的因素，并考虑针对这一特定人群的替代管理方法，与老年病学和急诊医师更好地合作，这将是很有趣的。
