The study conducted by researchers at University of Western Australia and the Royal Perth Hospital and the Catherine McAuley Nursing Home, is reported in the latest issue of the Medical Journal of Australia.
The study which was conducted for a period of 6 months in 2002, has revealed that less than 13.1 per cent of the residents at the Royal Perth Hospital have been transferred. Fractures, infections, medical procedures that could not be carried at the nursing home such as plaster application, X-rays, intravenous administration of antibiotics, suspicion of a stroke were some conditions that necessitated transfer of aged home residents.
One reason behind the low ED presentation could be explained by enhanced involvement of nursing home staff and GPs. It was also found that nearly two thirds of the cases could have been effectively managed by GP. Additionally, training of nursing home staff regarding management of indwelling urinary catheters or gastrotomy tubes could have avoided a visit to the ED in nearly 24% of the cases. The relatively low availability of funds prevented provision of such a training.
'It is hoped that the MedicarePlus initiatives and the formation of residential aged care panels may provide the mechanism for greater GP availability and training of all members of the health care team in residential care facilities,' said the study authors.
Referring to the Gold Coast Hospital's pilot 'Hospital in the Nursing Home' program, they said that 'The service has treated 400 patients, resulting in hospital bed-day savings of more than 1,500 days over two years and allowing residents to stay in familiar surrounding while receiving acute care. This would appear to be a positive outcome for all parties, but a randomized controlled trial would be needed to confirm the effectiveness of the intervention,' said Dr. Kurrle.
'The substantial majority of . . . presentations were considered to be appropriate. These patients were acutely unwell and required the investigations and expertise available in the ED, they concluded.