In our efforts to reduce unnecessary hospital admissions and readmissions we often find that many patients are coming to the hospital emergency department from skilled nursing facilities or other long-term care facilities. And we often find that such visits could have been avoided had there been access to more medical evaluation and management at those SNF/LTC’s.
Those trips to the ED may be inconvenient for patients and are costly in terms of transportation and time required for staff involvement. Now there is an even more cogent argument for making such resources available at those sites and avoiding trips to the ED. A Canadian study (Quach 2012) has found that the rate of new respiratory or GI infections is almost 4 times higher in LTC residents in the week following a visit to the ED. They note that this puts the entire SNF/LTC at risk for an outbreak of infection and suggest it might be reasonable to exercise additional precautions for 5-7 days for patients returning from ED visits.
The authors don’t state what those additional precautions might be. However, one might anticipate they would include some measures to limit those patients interacting with other patients (eg. taking meals in room rather than in a group setting) and perhaps some sort of contact isolation procedures. But you need to beware that these precautions may also have unintended consequences. In particular, residents of LTC facilities tend to be more prone to delirium and we might see more delirium in patients put on these precautions (see our January 17, 2012 Patient Safety Tip of the Week “Delirium and Contact Isolation”).
Quach C, McArthur M, McGeer A, et al. Risk of infection following a visit to the emergency department: a cohort study. CMAJ 2012; January 23, 2012