Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

BACKGROUND: Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. PURPOSE: The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. METHODS: A case-crossover design within a retrospective cohort of adult home care patients in Ontario. RESULTS: A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15-1.60) vs. 1.21 (95% CI 1.15-1.28)). No other clinical indicator modified the association. CONCLUSIONS: The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.