ED transfers less likely for metro residents

Residents in rural regions are more likely to be transferred to hospital following an ambulance callout than their counterparts in metropolitan facilities, a new study shows.

Residents in rural regions are more likely to be transferred to hospital following an ambulance callout than their counterparts in metropolitan facilities, a new study shows.

The research led by Monash University PhD student Dr Rosie Dwyer also found that comorbidities increased the chances of residents going to hospital.

The researchers used clinical and administrative data from Ambulance Victoria and the Australian Bureau of Statisticstoexamine the outcomes of all emergency ambulance callouts to residential aged care facilities across metropolitan and rural regions in the state from 2008 to 2013.

Professor Judy Lowthian

The study found it was more likely for residents living in rural areas than those in metropolitan areas to be transferred to a hospital following an emergency ambulance call out, said Professor Judy Lowthian, Dr Dwyer’s PhD supervisor.

“The increased odds of transfer for people living in regional care homes may reflect a relative deficiency of alternate acute care services in these areas,” Professor Lowthian told Australian Ageing Agenda.

“In addition, transfer to hospital was more likely for residents with a history of depression, heart disease and osteoporosis, those prescribed antipsychotic medication, and in cases of suspected fracture, head injury or febrile illness,” said Professor Lowthian, principal research fellow and head of research at the Bolton Clarke Research Institute.

The study also found that hospital transfers were lower for residents with chronic pulmonary disease and congestive cardiac failure.

However, ambulance callouts within business hours were more likely to lead to a transfer to hospital than after-hours callouts.

It is not possible with the available data to identify why some factors were associated with higher odds of hospital transfers than others, said Professor Lowthian.

“Some may be due to requiring an intervention outside a paramedic’s scope of practice, while others such as suspected stroke, cardiac arrhythmia or respiratory tract infection may be due to acuity of associated symptoms or requirement for investigations such as CT and X-ray, which are less accessible by prehospital or community clinicians,” she said.

Professor Lowthian said the study would help identify residents who are at heightened risk of an unplanned emergency department transfer.

“Some of these factors are potentially modifiable through enhanced primary care. For example, regular medication reviews to reduce the consequences of inappropriate polypharmacy, including prescription of certain medications such as antipsychotic agents,” Professor Lowthian said.

“The study findings may assist emergency ambulance services in predicting need for transport and, therefore, in refining the efficient and timely allocation of resources,” she said.

The research was published in the Australasian Journal on Ageing in June. Access it here.

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Tags: ambulance callout, ambulance-services, Bolton Clarke Research Institute, dr rosie dwyer, emergency-department, monash-university, professor judy lowthian, research,

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