Aim: Determine the proportion of appropriate transfers from residential aged care facilities (RACFs) to the Emergency Department (ED) assessed from the perspective of geriatricians; highlighting the vulnerabilities in the system and the key role the critical care interface plays for these patients.
Method: Review of emergency department electronic records at an outer metropolitan public teaching hospital with a high number (>40) of nearby RACFs. Appropriateness was assessed using a consensus approach designed by the local geriatric department.
Results: The first 250 RACF presentations were assessed as a representative sample of the 2005 transfers in 2021. Transfers originated from 41 facilities and were appropriate in 76% (n=190), ranging 75-87.5% from the 5 most frequently referring facilities. Infectious and neurologic presentations were significantly more likely to be appropriate (Total n=49, 93.4%, (p=.001) and n=49, 91.8% (p=.004) respectively) while respiratory (n= 19, 52.6% (p=.01)) and metabolic derangements (n=35, 5.7% (p=<.001)) were likely to be suitable for community management.
Age, cognition, facility of origin, presence of urologic device or ED presentation within 12 months were not associated with appropriateness. Despite 78% (n= 195) of cases having presentations in the prior 12 months, only 32.8% (n=32) had documentation of family discussions or goals of care.
Conclusion: Most local RACF transfers are appropriate, despite a high rate of recent presentation. This assessment approach was effective in assessing local patterns and vulnerabilities and could be used in other similar catchments. Additionally, it refutes concerns about inappropriate or excessive use of ED services by RACF residents.