Guan Gigi, Michel Kadison, Corke Charlie, Ranmuthugala Geetha
Department of Rural Health, Melbourne Medical School, The University of Melbourne, Shepparton, VIC 3630, Australia.
Critical Care Unit, Goulburn Valley Health, Shepparton, VIC 3630, Australia.
J Clin Med. 2025 Jul 21;14(14):5169. doi: 10.3390/jcm14145169.
Falls in residential aged care facilities (RACFs) have a significant impact, often leading to costly and unnecessary emergency department (ED) transfers. This scoping review examined the ED discharge proportions and patient characteristics of RACF residents presenting to the ED following a fall, to identify factors that could reduce unnecessary ED transfers. The databases MEDLINE, CINAHL, Scopus, and Web of Science were searched, resulting in an initial 1385 articles. Nine of these articles met the inclusion criteria and were included in this review. The median age of patients reported in the nine papers ranged from 80.8 to 88 years. Discharge proportions from ED back to RACF ranged from 36% to 91%, with an average of 63%. The studies that reported on computed tomography of the brain (CTB) showed that CTB findings did not significantly influence discharge decisions. Many RACF residents transferred to EDs following falls are discharged without hospital admission. The heterogeneity of study methods makes it challenging to draw definitive conclusions about factors that may help identify patient groups that do not require transfer to the ED following a fall. However, this scoping review highlights potential opportunities to reduce ED transfers from RCAFs. These findings highlight a need for geriatric-specific, person-centred protocols that reduce unnecessary ED transfers while safeguarding quality of care and respecting residents' advance care preferences.
老年护理机构（RACFs）中的跌倒具有重大影响，常常导致代价高昂且不必要的急诊科（ED）转诊。本综述研究了跌倒后前往急诊科的RACF居民的急诊科出院比例和患者特征，以确定可减少不必要急诊科转诊的因素。检索了MEDLINE、CINAHL、Scopus和Web of Science数据库，初步检索到1385篇文章。其中9篇文章符合纳入标准并被纳入本综述。这9篇论文中报告的患者年龄中位数在80.8至88岁之间。从急诊科转回RACF的出院比例在36%至91%之间，平均为63%。报告了脑部计算机断层扫描（CTB）的研究表明，CTB结果对出院决策没有显著影响。许多跌倒后被转诊至急诊科的RACF居民在未住院的情况下出院。研究方法的异质性使得难以就可能有助于识别跌倒后无需转诊至急诊科的患者群体的因素得出明确结论。然而，本综述强调了减少RACF向急诊科转诊的潜在机会。这些发现凸显了制定针对老年人的、以患者为中心的方案的必要性，这些方案在保障护理质量和尊重居民预先护理偏好的同时，减少不必要的急诊科转诊。
