Nursing Homes Should Identify Potentially Preventable Emergency Department Visits by Their Residents

Emergency Department (ED) visits and subsequent hospital admissions from nursing homes (NHs) are common and can be costly to the patient and the health care system. Unfortunately, many of the over 2.2 million ED visits annually by nursing home residents are preventable. The Office of the Inspector General reported that 22% of Medicare beneficiaries experienced an adverse event leading to harm (usually hospital admission) while staying in a skilled NH, and that 60% of these were considered preventable by physician reviewers if better care processes had been used.

A recent study identified and described potentially preventable ED visits by NH residents in the United States. Using a nationally representative sample of older NH residents, the study compared ED visits by NH residents that were not admitted to the hospital (potentially preventable) with those that led to admission (less likely preventable). The study ultimately showed that ED visits for injury, those that are linked with normal triage vital signs, and those that are not linked with any diagnostic testing are potentially preventable.  Residents who are discharged from the ED commonly undergo crucial testing and receive medications that could alter their physical examination on return to the nursing facility, emphasizing the need for seamless communication throughout the journey from the ED to NHs.