Emergency department presentations and 30-day mortality in patients from residential aged care facilities.

Objective: To describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF). Methods: A retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages. All patients aged ≥65 years presenting to the ED from a RACF between January 2017 and July 2018 were included. ED diagnosis categories, re-admission rates within 30 days and 30-day all-cause mortality were measured. Results: In total, 43 248 presentations were identified. The most common ED diagnosis categories were: injury (26.48%), respiratory conditions (14.12%) and cardiovascular conditions (10.74%). Prolonged ED length of stay was associated with higher adjusted hazard ratios for 30-day all-cause mortality after adjustments for age Charlson Comorbidity Index, triage category and diagnosis category (HR 1.10 95% CI 1.05–1.14 P < 0.001). Conclusions: A large proportion of ED presentations from RACFs were for injuries associated with falls and chest infections. There was a range of both high- and low-urgency presentations. Both the 30-day mortality and re-admission rates were high. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. The findings are useful in informing discussion around improving access to care in RACFs and coordination of healthcare providers in this cohort. What is known about the topic? Patients from residential aged care facilities (RACFs) presenting to emergency departments (EDs) are a vulnerable population with higher rates of complex medical morbidity, frailty, and cognitive impairment. There are increased rates of presentation, repeat visits and increased hospital- acquired complications, morbidity, and mortality in this population. There are many suggestions for improving primary care delivered in RACFs. What does this paper add? State-wide linkage of data to examine patterns of ED presentations from RACFs and associated 30-day mortality. Injuries and chest infections were the most common presentations. Both 30-day mortality and re-admission rates were high for patients from RACFs. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. What are the implications for practitioners? Provides evidence for increasing access to clinical care in RACFs and improving coordination of care to more effectively manage acute illness and injury. Timely advanced care planning and discussion of goals of care is an opportunity to prevent avoidable presentations to the ED. More research into falls management and managing respiratory infections in RACFs is required to facilitate better community-based care for this population. [ABSTRACT FROM AUTHOR]