Skip to main content
Top
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2015 | Research article

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study

Authors: Lijun Fan, Xiang-Yu Hou, Jingzhou Zhao, Jiandong Sun, Kaeleen Dingle, Rhonda Purtill, Sam Tapp, Bill Lukin

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs).

Methods

A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis.

Results

Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196).

Conclusions

Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.
Literature
1.
go back to reference Australian Institute of Health and Welfare. Residential aged care in Australia 2010-11: a statistical overview. Canberra: AIHW; 2012. Australian Institute of Health and Welfare. Residential aged care in Australia 2010-11: a statistical overview. Canberra: AIHW; 2012.
2.
go back to reference Arendts G, Quine S, Howard K. Decision to transfer to an emergency department from residential aged care: a systematic review of qualitative research. Geriatr Gerontol Int. 2013;13(4):825–33.CrossRefPubMed Arendts G, Quine S, Howard K. Decision to transfer to an emergency department from residential aged care: a systematic review of qualitative research. Geriatr Gerontol Int. 2013;13(4):825–33.CrossRefPubMed
3.
go back to reference Arendts G, Etherton-Beer C, Howard K, Lewin G, Sim M, Pickstock S, et al. Nurse led care coordination: trial protocol and development of a best practice resource guide for a cluster controlled clinical trial in Australian aged care facilities. Arch Gerontol Geriatr. 2014;58(1):15–9.CrossRefPubMed Arendts G, Etherton-Beer C, Howard K, Lewin G, Sim M, Pickstock S, et al. Nurse led care coordination: trial protocol and development of a best practice resource guide for a cluster controlled clinical trial in Australian aged care facilities. Arch Gerontol Geriatr. 2014;58(1):15–9.CrossRefPubMed
4.
go back to reference Arendts G, Fitzhardinge S, Pronk K, Hutton M. Front‐loading allied health intervention in the emergency department does not reduce length of stay for admitted older patients. Int J Clin Pract. 2013;67(8):807–10.CrossRefPubMed Arendts G, Fitzhardinge S, Pronk K, Hutton M. Front‐loading allied health intervention in the emergency department does not reduce length of stay for admitted older patients. Int J Clin Pract. 2013;67(8):807–10.CrossRefPubMed
5.
go back to reference Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36.CrossRefPubMed Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36.CrossRefPubMed
6.
go back to reference Fan L, Lukin W, Zhao J, Sun J, Hou X-Y. Interventions targeting the elderly population to reduce emergency department utilisation: a literature review. Emerg Med J. 2015;32(9):738-743. Fan L, Lukin W, Zhao J, Sun J, Hou X-Y. Interventions targeting the elderly population to reduce emergency department utilisation: a literature review. Emerg Med J. 2015;32(9):738-743.
7.
go back to reference Jones JS, Dwyer PR, White LJ, Firman R. Patient transfer from nursing home to emergency department: outcomes and policy implications. Acad Emerg Med. 1997;4(9):908–15.CrossRefPubMed Jones JS, Dwyer PR, White LJ, Firman R. Patient transfer from nursing home to emergency department: outcomes and policy implications. Acad Emerg Med. 1997;4(9):908–15.CrossRefPubMed
8.
go back to reference Crilly J, Chaboyer W, Wallis M. A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. J Adv Nurs. 2012;68(2):322–34.CrossRefPubMed Crilly J, Chaboyer W, Wallis M. A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. J Adv Nurs. 2012;68(2):322–34.CrossRefPubMed
9.
go back to reference Australian Institute of Health and Welfare. Australian hospital statistics 2013–14: emergency department care. Canberra: AIHW; 2014. Australian Institute of Health and Welfare. Australian hospital statistics 2013–14: emergency department care. Canberra: AIHW; 2014.
10.
go back to reference Australian Institute of Health and Welfare. Australia’s hospitals 2012–13 at a glance. Canberra: AIHW; 2014. Australian Institute of Health and Welfare. Australia’s hospitals 2012–13 at a glance. Canberra: AIHW; 2014.
11.
go back to reference Cavalieri T, Chopra A, Gray-Miceli D, Shreve S, Waxman H, Forman L. Geriatric assessment teams in nursing homes: do they work? J Am Osteopath Assoc. 1993;93(12):1269–72.PubMed Cavalieri T, Chopra A, Gray-Miceli D, Shreve S, Waxman H, Forman L. Geriatric assessment teams in nursing homes: do they work? J Am Osteopath Assoc. 1993;93(12):1269–72.PubMed
12.
go back to reference Codde J, Arendts G, Frankel J, Ivey M, Reibel T, Bowen S, et al. Transfers from residential aged care facilities to the emergency department are reduced through improved primary care services: an intervention study. Australas J Ageing. 2010;29(4):150–4.CrossRefPubMed Codde J, Arendts G, Frankel J, Ivey M, Reibel T, Bowen S, et al. Transfers from residential aged care facilities to the emergency department are reduced through improved primary care services: an intervention study. Australas J Ageing. 2010;29(4):150–4.CrossRefPubMed
13.
go back to reference Burl JB, Bonner A, Rao M, Khan AM. Geriatric nurse practitioners in long-term care: demonstration of effectiveness in managed care. J Am Geriatr Soc. 1998;46(4):506–10.CrossRefPubMed Burl JB, Bonner A, Rao M, Khan AM. Geriatric nurse practitioners in long-term care: demonstration of effectiveness in managed care. J Am Geriatr Soc. 1998;46(4):506–10.CrossRefPubMed
14.
go back to reference Kane RL, Garrard J, Skay CL, Radosevich DM, Buchanan JL, McDermott SM, et al. Effects of a geriatric nurse practitioner on process and outcome of nursing home care. Am J Public Health. 1989;79(9):1271–7.PubMedCentralCrossRefPubMed Kane RL, Garrard J, Skay CL, Radosevich DM, Buchanan JL, McDermott SM, et al. Effects of a geriatric nurse practitioner on process and outcome of nursing home care. Am J Public Health. 1989;79(9):1271–7.PubMedCentralCrossRefPubMed
15.
go back to reference Kane RL, Garrard J, Buchanan JL, Rosenfeld A, Skay C, McDermott S. Improving primary care in nursing homes. J Am Geriatr Soc. 1991;39(4):359–67.CrossRefPubMed Kane RL, Garrard J, Buchanan JL, Rosenfeld A, Skay C, McDermott S. Improving primary care in nursing homes. J Am Geriatr Soc. 1991;39(4):359–67.CrossRefPubMed
16.
go back to reference Aigner MJ, Drew S, Phipps J. A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. J Am Med Dir Assoc. 2004;5(1):16–23.CrossRefPubMed Aigner MJ, Drew S, Phipps J. A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. J Am Med Dir Assoc. 2004;5(1):16–23.CrossRefPubMed
17.
go back to reference Damiani G, Federico B, Venditti A, Sicuro L, Rinaldi S, Cirio F, et al. Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates? BMC Health Serv Res. 2009;9(1):22.PubMedCentralCrossRefPubMed Damiani G, Federico B, Venditti A, Sicuro L, Rinaldi S, Cirio F, et al. Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates? BMC Health Serv Res. 2009;9(1):22.PubMedCentralCrossRefPubMed
18.
go back to reference Codde J, Frankel J, Arendts G, Babich P. Quantification of the proportion of transfers from residential aged care facilities to the emergency department that could be avoided through improved primary care services. Australas J Ageing. 2010;29(4):167–71.CrossRefPubMed Codde J, Frankel J, Arendts G, Babich P. Quantification of the proportion of transfers from residential aged care facilities to the emergency department that could be avoided through improved primary care services. Australas J Ageing. 2010;29(4):167–71.CrossRefPubMed
19.
go back to reference Finn JC, Flicker L, Mackenzie E, Jacobs IG, Fatovich DM, Drummond S, et al. Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia. Med J Aust. 2006;184(9):432.PubMed Finn JC, Flicker L, Mackenzie E, Jacobs IG, Fatovich DM, Drummond S, et al. Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia. Med J Aust. 2006;184(9):432.PubMed
20.
go back to reference Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the emergency department be avoided through improved primary care services? Data from qualitative interviews. Australas J Ageing. 2010;29(2):61–5.CrossRefPubMed Arendts G, Reibel T, Codde J, Frankel J. Can transfers from residential aged care facilities to the emergency department be avoided through improved primary care services? Data from qualitative interviews. Australas J Ageing. 2010;29(2):61–5.CrossRefPubMed
21.
go back to reference Bergman H, Clarfield A. Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions. J Am Geriatr Soc. 1991;39(12):1164–8.CrossRefPubMed Bergman H, Clarfield A. Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions. J Am Geriatr Soc. 1991;39(12):1164–8.CrossRefPubMed
22.
go back to reference Saliba D, Kington R, Buchanan J, Bell R, Wang M, Lee M, et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc. 2000;48(2):154–63.CrossRefPubMed Saliba D, Kington R, Buchanan J, Bell R, Wang M, Lee M, et al. Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc. 2000;48(2):154–63.CrossRefPubMed
23.
go back to reference Kayser-Jones J, Wiener CL, Barbaccia JC. Factors contributing to the hospitalization of nursing home residents. Gerontologist. 1989;29(4):502–10.CrossRefPubMed Kayser-Jones J, Wiener CL, Barbaccia JC. Factors contributing to the hospitalization of nursing home residents. Gerontologist. 1989;29(4):502–10.CrossRefPubMed
24.
go back to reference Kerr H, Byrd J. Nursing home patients transferred by ambulance to a VA emergency department. J Am Geriatr Soc. 1991;39(2):132–6.CrossRefPubMed Kerr H, Byrd J. Nursing home patients transferred by ambulance to a VA emergency department. J Am Geriatr Soc. 1991;39(2):132–6.CrossRefPubMed
25.
go back to reference Carter MW. Factors associated with ambulatory care—sensitive hospitalizations among nursing home residents. J Aging Health. 2003;15(2):295–331.CrossRefPubMed Carter MW. Factors associated with ambulatory care—sensitive hospitalizations among nursing home residents. J Aging Health. 2003;15(2):295–331.CrossRefPubMed
26.
go back to reference O’Connell B, Hawkins M, Considine J, Au C. Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp. Contemp Nurse. 2013;45(2):228–33.CrossRefPubMed O’Connell B, Hawkins M, Considine J, Au C. Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp. Contemp Nurse. 2013;45(2):228–33.CrossRefPubMed
27.
go back to reference Arendts G, Howard K. The interface between residential aged care and the emergency department: a systematic review. Age Ageing. 2010;39(3):306–12.CrossRefPubMed Arendts G, Howard K. The interface between residential aged care and the emergency department: a systematic review. Age Ageing. 2010;39(3):306–12.CrossRefPubMed
28.
go back to reference Arendts G, Dickson C, Howard K, Quine S. Transfer from residential aged care to emergency departments: an analysis of patient outcomes. Intern Med J. 2012;42(1):75–82.CrossRefPubMed Arendts G, Dickson C, Howard K, Quine S. Transfer from residential aged care to emergency departments: an analysis of patient outcomes. Intern Med J. 2012;42(1):75–82.CrossRefPubMed
Metadata
Title
Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study
Authors
Lijun Fan
Xiang-Yu Hou
Jingzhou Zhao
Jiandong Sun
Kaeleen Dingle
Rhonda Purtill
Sam Tapp
Bill Lukin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1275-z

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue