Elderly patients re-transferred from long-term care hospitals to emergency departments within 48 h.

Background & objectives: The increasing proportion of elderly populations has led to a rise in chronic diseases and frequent transfers between long-term care hospitals (LTCHs) and emergency departments (EDs). This study investigates the patterns of risk factors of initial-transfers and subsequent re-transfers among patients aged 65 or older. Specifically, we focus on those re-transferred from LTCHs to EDs within 48 h of discharge, often without adequate treatment.

Method: This nationwide cross-sectional study used data from South Korea's National Emergency Department Information System (NEDIS) from January 1, 2017, to December 31, 2019. Patients aged 65 or older who were initially transferred from LTCHs to EDs and re-transferred within 48 h, were identified. Logistic regression was employed to analyze risk factors associated with re-transfers.

Results: 140,282 elderly patients were identified as having been transferred from LTCHs to EDs. Of these, 38,180 patients received emergency care in the EDs and were discharged back to LTCHs. Among them, 679 patients were returned to LTCHs after receiving acute treatment but revisited the EDs within 48 h. Hospital ward admission rates were higher for re-transferred patients (71.3%) compared to initial transfers (42.1%, p < 0.0001). Risk factors for re-transfer included male, nighttime admissions, and longer ED stays (> 6 h). Tertiary hospitals showed higher re-transfer rates to other facilities (13.1%) than general hospitals (2.9%).

Conclusion: This study reveals that many health outcomes worsen upon re-transfer compared to the initial-transfer. These findings underscore the need for a coordinated healthcare system that ensures elderly patients from long-term care facilities are initially sent to appropriate hospitals during the initial transfer, which could mitigate repeated ED visits and ensure timely care.