Older patients referred by community nurses to emergency departments--a descriptive cross-sectional follow-up study in a Swedish context

Objectives: The objective of this study was to examine on what extent nursing home (NH) older patients aged 75 or older, referred to hospitals by registered nurses (RNs) in the community, utilise the emergency department (ED) over a 1-year period and for what reason. A further objective was to identify factors that may explain these referrals.

Methods: A cross-sectional follow-up study, examining older patients' disabilities, resources and needs, was carried out in a county in Sweden. Assessments were made using Residents Assessment Instrument/Minimum Data Set, among 719 individuals in 24 NHs and the RNs' documentation were followed.

Results: The result showed that of 719 residents, 209 accounted for 314 referrals to an ED over the 1-year period. No gender differences were observed. The main reasons for referrals were falls (23%), cardiovascular problems (16%), gastrointestinal problems (12%) and infections (11%). Most of the referrals (65%) were made on weekdays during daytime hours. In 62% of the cases, there had been a consultation with a physician prior to the referral. The nursing documentation was poor in connection with the referral.

Conclusion: Older patients with dementia diseases were significant less refereed and questions are raised whether this group is undetected and undertreated, and therefore, it is important with further investigation.