EMERGENCY DEPARTMENT USE BY NURSING-HOME RESIDENTS

Study objective: To describe a community's experience with the use of emergency department services by nursing home residents. Methods: We p erformed a retrospective chart review of a population-based cohort of nursing home residents in an urban county in central Georgia with 10 n ursing homes (1,300 beds) and 4 hospital-based EDs. All ED visits by n ursing home residents during 1995 were analyzed. Demographic data, tim ing of the visit, chief complaint, tests and treatments, disposition, and financial charges were recorded. Further, we calculated the number of ED visits per 100 nursing home patient-years. Results: A total of 873 nursing home residents made 1,488 ED visits. Mean age was 76.0 yea rs; 66.4% were female, and 55.2% were white. Of the transfers, 42.9% o ccurred during regular working hours. The most common chief complaints were respiratory symptoms (14.4%), altered mental status (10.1%), gas trointestinal symptoms (9.9%), and falls (8.2%); 101 patients (6.8%) w ere transferred for malfunction of a gastrostomy tube. The most common laboratory tests were complete blood cell count (69.5%), chest radiog raph (52.0%), electrocardiogram (45.0%), urinalysis (42.7%), and deter mination of electrolytes (42.7%). A total of 42.4% of the ED visits le d to admission to the hospital. From the 10 nursing homes, there were 110 ED visits per 100 patient-years. A 3.5-fold difference in ED use a mong these nursing homes could not be explained by age, gender, or oth er factors. The average charge per ED visit was $1,239. Conclusion: El ders living in nursing homes are frequently transferred to EDs for cos tly medical evaluations, and more than 40% of such visits lead to admi ssion to the hospital.