Nursing Role in Managing Patients with Recurrent Emergency Department Visits
DOI:
https://doi.org/10.22399/ijcesen.4728Keywords:
Nursing, Emergency Department, Frequent Utilizers, Care Coordination, Transitional Care, Holistic AssessmentAbstract
Nursing plays a pivotal and multifaceted role in breaking the cycle of recurrent Emergency Department (ED) visits by addressing the complex biomedical, psychological, and social determinants that drive this high-risk behavior. Moving beyond episodic crisis intervention, nurses employ holistic assessments to identify root causes such as unmet mental health needs, medication non-adherence, and socioeconomic instability. Through skilled care coordination and transitional planning, they bridge the critical gap between the ED and community-based services, ensuring seamless linkages to primary care, social support, and chronic disease management programs. The therapeutic nurse-patient relationship, built on trust and motivational interviewing, fosters engagement and empowers patients with tailored education for improved self-management. Furthermore, nurses lead interdisciplinary initiatives and advocate for systemic reforms, positioning them as essential agents in transforming the ED from a revolving door into a portal to sustainable, patient-centered health outcomes.
References
1. Gu Z, Eils R, Schlesner M. Complex heatmaps reveal patterns and correlations in multidimensional genomic data. Bioinformatics. 2016;32(18):2847–9.
2. REGIONE PIEMONTE. Deliberazione della Giunta Regionale 30 luglio. 2012, n. 45-4248 Il nuovo modello integrato di assistenza residenziale e semiresidenziale socio-sanitaria a favore delle persone anziane non autosufficienti. Modifica D.G.R. n. 25-12129 del 14.09.09 e D.G.R. n. 35-9199 del 14.07.08. Revoca precedenti deliberazioni.
3. Istituto Nazionale di Statistica. Residential Care Facilities. ISTAT. Published 2018.
4. Regulation (EU) 2016/679 of the European Parliament and of the Council. (Text with EEA relevance). Official J Eur Union. 2016;59:L119.
5. Chyr LC, Drabo EF, Fabius CD. Patterns and predictors of transitions across Residential Care settings and nursing homes among Community-Dwelling older adults in the United States. Gerontologist. 2020;60(8):1495–503.
6. Eurostat. Ageing Europe - statistics on population developments. Eurostat. 2023.
7. Italian Personal Data Protection Code. Legislative Decree No. 196 of 30 June 2003. Gazzetta Ufficiale della Repubblica Italiana. 2003.
8. Kirsebom M, Hedström M, Pöder U, Wadensten B. Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates. Nurs Open. 2017;4(1):41–8.
9. Istituto Nazionale di Statistica. Anziani.Stat dati e indicatori sull’invecchiamento della popolazione in Italia. ISTAT. Published April 18, 2023.
10. Carron PN, Mabire C, Yersin B, Büla C. Nursing home residents at the Emergency Department: a 6-year retrospective analysis in a Swiss academic hospital. Intern Emerg Med. 2017;12(2):229–37.
11. Deliberazione della Giunta Regionale 23 dicembre. 2003, n.51-1138 D.P.C.M. 29 novembre 2001, Allegato 1, Punto 1.C. Applicazione Livelli Essenziali di Assistenza all’area dell’integrazione socio-sanitaria B.U.R. 31.12.2003, n. 53.
12. Guarducci G, Lorenzini C, Ciacci D, Righi L, Pastorelli M, Nante N. How to reduce erroneous Emergency Department admissions for the frail elderly. Ann Ig. 2023.
13. Gelman A, Carlin JB, Stern HS, Dunson DB, Vehtari A, Rubin DB. Bayesian Data Analysis. 3rd ed. Chapman and Hall/CRC.; 2013.
14. REGIONE PIEMONTE. Deliberazione della Giunta Regionale 24 aprile 2006, n. 28-2690 Approvazione dell’Accordo Integrativo Regionale per la Medicina Generale 2006.
15. Briggs R, Coughlan T, Collins R, O’Neill D, Kennelly SP. Nursing home residents attending the emergency department: clinical characteristics and outcomes. QJM. 2013;106(9):803–8.
16. Decreto legislativo relativo alla revisione. e semplificazione delle disposizioni in materia di prevenzione della corruzione, pubblicità e trasparenza correttivo della legge 6 novembre 2012, N.190 e del decreto legislativo 14 Marzo 2013, n.33, ai sensi dell’articolo 7 della legge 7 agosto 2015, n.124 in materia di riorganizzazione delle amministrazioni pubbliche.
17. Giebel C, Harvey D, Akpan A, Chamberlain P. Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP) BMC Health Serv Res. 2020;20(1):94.
18. STER– Regional Information Flow of Informative, Residential, and Semi-residential Services. Regional Council Resolution No. 13-6981 of December 30, 2013 Regional System of Health Information Flows - Provisions for Public Health Care and Accredited Informative Institutes Present in the Regional Territory, Regarding Information Obligations and Transmission Timelines for Health Services Provided.
19. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria. 2016.
20. Serina PT, Xu C, Baird J, Wang HE, Donnelly JP, Amanullah S, Lo AX. Emergency department resource utilization among nursing home residents, a National Cross-sectional Study. Am J Emerg Med. 2024.
21. World Health Organization. WHO Study on global AGEing and adult health (SAGE). WHO. Published 2023.
22. Graverholt B, Forsetlund L, Jamtvedt G. Reducing hospital admissions from nursing homes: a systematic review. BMC Health Serv Res. 2014;14(1):36.
23. Haber SG, Wensky SG, McCall NT. Reducing Inpatient Hospital and Emergency Room utilization among nursing home residents. J Aging Health. 2017;29(3):510–30.
24. Decreto del Presidente del Consiglio dei Ministri . Atto Di Indirizzo E Coordinamento Dell’attivita’ Amministrativa Delle Regioni E Province Autonome Concernente La Realizzazione Di Strutture Sanitarie Residenziali per anziani non autosufficienti non assistibili a Domicilio o Nei Servizi Semiresidenziali. Italy: GU; 1999.
25. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr. 2019;19(1):17.
26. Moore DC, Keegan TJ, Dunleavy L, Froggatt K. Factors associated with length of stay in care homes: a systematic review of international literature. Syst Rev. 2019;8(1):56.
27. Regione Piemonte. Piedmont general information. Consiglio Regionale del Piemonte. Published 2023.
28. Stephens CE, Newcomer R, Blegen M, Miller B, Harrington C. Emergency Department use by nursing home residents: Effect of Severity of Cognitive Impairment. Gerontologist. 2012;52(3):383–93.
29. Ministero della Salute. Manuale ICD-9-CM versione italiana 2007. Published 2007.
30. Italian Personal Data Protection Code. Legislative decree 101 of 10 August 2018. Gazz Ufficiale Della Repubblica Italiana. 2018;205.
31. Wang HE, Shah MN, Allman RM, Kilgore M. Emergency Department visits by Nursing Home Residents in the United States. J Am Geriatr Soc. 2011;59(10):1864–72.
32. Campagna S, Conti A, Dimonte V, et al. Trends and Characteristics of Emergency Medical Services in Italy: a 5-Years Population-based Registry Analysis. Healthcare. 2020;8(4):551.
33. Aryal K, Mowbray F, Gruneir A, et al. Nursing home Resident Admission characteristics and potentially preventable Emergency Department transfers. J Am Med Dir Assoc. 2022;23(8):1291–6.
34. Kirsebom M, Hedström M, Wadensten B, Pöder U. The frequency of and reasons for acute hospital transfers of older nursing home residents. Arch Gerontol Geriatr. 2014;58(1):115–20.
35. Green E, Shaw SE, Harris T. ‘They shouldn’t be coming to the ED, should they?’ A qualitative study of why patients with palliative care needs present to the emergency department: Table 1. BMJ Support Palliat Care. May 2016.
36. Ministero della Salute. Commissione nazionale aggiornamento LEA. Ministero della Salute. Published 2021.
37. Regione Piemonte. Flussi Informativi Regionali. Published 2022.
38. Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Physical frailty and cognitive impairment in older nursing home residents: a latent class analysis. BMC Geriatr. 2021;21(1):487.
39. Decreto legislativo del 14/03/2013 n. 33 - Riordino della disciplina riguardante il diritto di accesso civico e gli obblighi di pubblicita’, trasparenza e diffusione di informazioni da parte delle pubbliche amministrazioni. Gazzetta Ufficiale della Repubblica Italiana; 2013.
40. Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J. A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing. 2014;43(6):759–66.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 International Journal of Computational and Experimental Science and Engineering

This work is licensed under a Creative Commons Attribution 4.0 International License.