European Geriatric Medicine (2018) 9:339–346
Organizational and environmental factors associated with transfers
of nursing home residents to emergency departments
· Philipe de Souto Barreto
· Yves Rolland
Received: 29 January 2018 / Accepted: 30 April 2018 / Published online: 8 May 2018
© European Geriatric Medicine Society 2018
Background/Objectives The emergency department transfer (EDT) rate of residents from nursing homes (NHs) to emer-
gency departments is an important public health issue. The purpose of this study was to examine whether organizational and
geographical factors were associated with EDT among older adults living in NHs.
Design Retrospective analysis using information from patients’ medical charts regarding hospitalization in the last 12 months.
Information came from the baseline data of the IQUARE clinical trial.
Participants 5926 residents (86.0 years old, standard deviation, SD = 2.9), from 175 NHs with available data on EDT.
Outcome measure The EDT rate was estimated for each NH, from the number of residents who were transferred to an
emergency department (one transfer or more) in the previous 12 months.
Results 1119 (18.9%, SD = 11.5) residents were transferred to an emergency department at least once during the past year.
In adjusted multiple linear regression, NHs located in rural areas had an EDT rate signiﬁcantly lower than those in urban
areas (conﬁdence interval, 95% CI − 10.15, − 2.16, p = 0.003), with an absolute EDT rate of 16.4% (SD = 9.1) versus 20.4%
(SD = 12.5); pharmacy for internal use was signiﬁcantly associated with a lower EDT rate compared with the NHs with no
PUI [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI − 16.33, − 3.09, p = 0.004] and the implementation of a personalized
care project in NHs was signiﬁcantly associated with a lower EDT rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI
− 11.67, − 0.63, p = 0.03].
Conclusion Our study suggests that a structured plan of care, a strategy to improve medication and being located in rural
areas reduce the EDT rate in NH residents.
IQUARE study trial registration number NCT01703689.
Keywords Nursing homes · Emergency department · Hospitalization · Environmental · Elderly · Pharmacy
CN Coordinating physician
CP Coordinating nurse
ED Emergency department
EDT Emergency Department transfer (per year)
GMP Weighted average GIR
GP General Practitioner
95% CI 95% conﬁdence interval
INSEE National Institute of Statistics and Economic
IQUARE “l’Impact d’une démarche Qualité sur
l’évolution des pratiques et le déclin fonc-
tionnel des Résidents” (Impact of a Quality
approach on the development of practices and
the functional decline of residents)
NH Nursing Home
PUI Pharmacy for internal use
The annual rate of emergency department transfer (EDT)
of nursing home (NH) residents varies between 9 and
60% depending on the country and the region . Based
on various studies, 19–67% of unscheduled hospitaliza-
tions were potentially avoidable and/or inappropriate [1, 2].
Most of them result from geriatric syndromes such as falls,
* Xavier Dubucs
Gérontopôle, Centre Hospitalier Universitaire de Toulouse
(CHU Toulouse), Toulouse, France
UMR INSERM 1027, University of Toulouse III, Toulouse,