27APPROPRIATENESS OF NURSING HOME ADMISSIONS TO ACUTE SERVICES IN A DISTRICT GENERAL HOSPITAL: A 1-YEAR RETROSPECTIVE SURVEY

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Abstract

Introduction: Nursing home residents are often felt to be inappropriately transferred to acute services. The aim of our study was to retrospectively review and determine the appropriateness of all admissions from Nursing Homes to Perth Royal Infirmary (PRI) (a District General Hospital which covers 832 Nursing Home residents) over 12 months.

Sampling: We conducted a case note review for all acute admissions to PRI from 1 April 2009 to 30 March 2010. We recorded timing and source of admission, length of stay, outcome at discharge and at 90 days. Notes were independently reviewed by a consultant and registrar to determine whether admission was appropriate using two criteria: (i) condition could be safely managed without admission; (ii) condition so poor admission unlikely to change outcome.

Results: One hundred and sixty-seven individual admissions were included in this survey. Of the total, 95% of case notes were obtained. The mean age was 83 years and mean length of stay 6 days, accounting for 1,006 bed days; 12% of admissions (n = 20) were admitted to orthopaedics, 17% (n = 29) general surgery and 70% (n = 116) medicine; 53% of admissions were from A&E or out of hours services; 41% of admissions (n = 68) were deemed to be inappropriate. Of medical admissions 54% (n = 54) were felt to be inappropriate and 30% of these patients died during admission; 43% (n = 23) of medical admissions were felt to be in a condition so poor that admission was unlikely to change outcome with a 90-day mortality of 74% (n = 17).

Conclusions: Nursing home residents only accounted for a small number of acute admissions. A large number were not considered to be appropriate. Anticipatory care planning and closer liaison between medicine for the elderly, nursing homes and primary care has an important role in reducing unnecessary admissions in this vulnerable population.

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