Patients who receive in-home visits from nurses during the day are more likely to end up in the emergency room at night, a new Canadian study has found.
The research undermines the long-standing belief that in-home care visits can help reduce hospitalizations, or at least reveals that such evidence is mixed.
Patients with both ongoing conditions and short-term needs were more likely to wind up in the emergency room if they had a nursing visit earlier that day, according to the findings published Monday by the Canadian Medical Association Journal. The apparent link between nurse visits and ER trips was especially strong in cases that were not life threatening.
“For many situations, what you might think as being the answer, which is a nurse in the home, often sort of paradoxically leads to an emergency room visit,” Andrew Costa, lead author of the study and the Schlegel Chair in Clinical Epidemiology and Aging at McMaster University in Ontario, told Home Health Care News. “Typically, these are non-acute, non-urgent emergency room visits.”
The study’s overall finding were not surprising, Costa said. It’s generally accepted that patients who require in-home care have complex health histories, and nurses often aren’t “given the latitude within their rules” to directly deal with acute issues when they pop up.
Additionally, community-based nurses might not be fully integrated into primary care teams or, perhaps, limited in their scope of practice.
“The big takeaway is that we have some work to do in community and primary care around meeting the needs for frail, older adults in their homes,” Costa said.
The study was conducted in the region of Ontario with the largest number of 65-and-older adults. To investigate the relationship between in-home visits and ER stays, researchers cross-checked 2015 home care billing information with emergency department records.
Patients receiving care for ongoing conditions were largely frail, older adults with multiple chronic conditions, while patients receiving care for short-term needs tended to be younger individuals who required wound care, intravenous medication or rehabilitation needs.
Data came from more than 7,000 total home care patients and nearly 10,000 emergency room stays.
The study does not suggest visits from in-home nurses actually cause the ER trips.
“It’s not the fault of the nurse,” Costa said. “They’re some of the most valiant people working in the health care system, and it’s absolutely not easy to deliver care in people’s homes, going in an out of environments you don’t control…The bad part is that [going to the ER] seems to be the only option, or all too prevalent of an option.”
Instead of turning to the emergency room, patients and nurses should try to first seek the help of primary care providers who know patients best, he said.
“It’s really important for people to know that the emergency department, unless you absolutely need to be there, is a bad place to go,” Costa said.
The study was funded by a grant from the Canadian Frailty Network and the Canadian Institutes for Health Research.
Written by Robert Holly