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Emergency medicine
Original research
Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals
  1. Steef van den Broek1,
  2. Nikki Heiwegen2,
  3. Margot Verhofstad2,
  4. Reinier Akkermans3,4,
  5. Liselore van Westerop1,
  6. Yvonne Schoon2,5,
  7. Gijs Hesselink2,4
  1. 1Emergency Department, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
  2. 2Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
  3. 3Department of Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
  4. 4Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, Netherlands
  5. 5Department of Geriatrics, Radboudumc, Nijmegen, Gelderland, Netherlands
  1. Correspondence to Dr Steef van den Broek; s.vandenbroek{at}cwz.nl

Abstract

Objective Older adults are hospitalised from the emergency department (ED) without potentially needing hospital care. Knowledge about rates, associative factors and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to determine the rates, associative factors and causes for PEAs of older adults.

Design A mixed-method observational study.

Setting The EDs of two Dutch hospitals.

Participants 492 patients aged >70 years and hospitalised from the ED.

Measurements Quantitative data were retrospectively extracted from the electronical medical record over a 1-month period. Admissions were classified (non)preventable based on a standardised approach. Univariate and multivariate multilevel logistic regression analyses were performed to identify possible associations between PEAs and demographic, clinical and care process factors. Qualitative data were prospectively collected by email and telephone interviews and analysed thematically to explore hospital physician’s perceived causes for the identified PEAs.

Results Of the 492 included cases, 86 (17.5%) were classified as PEA. Patients with a higher age (adjusted OR 1.04, 95% CI 1.01 to 1.08; p=0.04), a low urgency classification (adjusted OR 1.89, 95% CI 1.14 to 3.15; p=0.01), and attending the ED in the weekend (adjusted OR 2.02, 95% CI 1.22 to 3.37; p<0.01) were associated with an increased likelihood of a PEA. 49 physicians were interviewed by telephone and email. Perceived causes for PEAs were related to patient’s attitudes (eg, postponement of medical care at home), provider’s attitudes (eg, deciding for admission after family pressure), health system deficiencies (eg, limited access to community services during out-of-hours and delayed access to inpatient diagnostic resources) and poor communication between primary care and hospital professionals about patient treatment preferences.

Conclusions Our findings contribute to existing evidence that many emergency admissions of older adults are preventable, thereby indicating a possible source of unnecessary expensive, and potentially harmful, hospital care.

  • accident & emergency medicine
  • geriatric medicine
  • primary care
  • preventive medicine
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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http://dx.doi.org/10.1136/bmjopen-2020-040431

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    Footnotes

    • Contributors GH and YS designed the study. MV and SvdB acquired the data. SvdB and GH performed the analyses. NH and LvW performed secondary assessment of data. All authors were involved in interpretation of data. SvdB and GH wrote the first draft of the manuscript. All authors were involved in revisions and approving the final manuscript for publication. SvdB is guarantor for the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The local ethics commission (CMO Arnhem-Nijmegen region) approved the study (registration number: 2018-4527).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The data that support the findings of this study (database with variables in SPSS) are available from the corresponding author, upon reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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    © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.