Incidence and Risk Factors of Unplanned Emergency Department Transfers From Italian Nursing Homes: A Prospective Multicentre Cohort Study

Abstract

ABSTRACT Aim To estimate the incidence of unplanned transfers to the emergency department among nursing home residents and to identify resident and organizational factors associated with transfer risk. Design A 12‐month prospective multicentre dynamic cohort study. Methods The study was conducted in nine nursing homes in a northern Italian region between July 2023 and June 2024. All long‐stay residents aged 65 years or older were included and followed for up to 12 months. Results A total of 643 residents were included; 204 residents experienced at least one unplanned transfer, accounting for 271 events during follow‐up. The incidence of first transfers was 4.47 per one hundred resident‐months and varied across facilities. At the resident level, recent admission, a higher number of chronic conditions and dependence in eating were associated with a higher likelihood of transfer, whereas female sex was associated with a lower likelihood. At the organizational level, larger bed capacity was associated with a lower risk of transfer. In contrast, the presence of a physician on site and a higher ratio of general practitioners to residents per occupied bed were associated with increased transfer risk. Conclusions Unplanned transfers from nursing homes to the emergency department are frequent. Strategies to reduce transfers should address resident vulnerability and organizational characteristics. Implications for the Profession and Patient Care Nurses should recognize the early period after admission as a critical window for risk stratification and advance care planning and consider how resident vulnerability and organizational characteristics influence transfer patterns. Impact Prospective evidence on unplanned transfers from nursing homes in Europe is limited. Nearly one third of residents experienced at least one transfer, highlighting the importance of addressing multimorbidity, functional dependence and organizational features when planning prevention strategies. Reporting Method The study adheres to STROBE guidelines. Patient or Public Contribution No patient or public contribution.