Impact of Video Regulation Associated With an Emergency Kit on Night Hospitalizations of the Residents of Nursing Homes in the Emergency Medical Dispatch Center.

Approximately 500,000 elderly people live in a nursing homes in France (1). Few studies concern these subjects: 2% of international research studies (1). Among the subjects hospitalised in the emergency department, those from a nursing home represent a significant proportion of the population, with a proportion of 9 to 37% (2). These are mainly elderly patients who are dependent in the acts of daily life, polypathological and with multiple medications (1,2) and for whom any aggression can lead to hospitalisation, a source of physical and psychological destabilisation (3).

Unplanned hospitalisations are frequent: one resident in ten has been hospitalised in the last three months, and up to five in ten over a full year. Ninety-five percent of the reasons for hospitalisation include cardiac decompensation, the consequences of falls, respiratory disorders, confusion, febrile or non-febrile infections, particularly dermatological, dehydration and gastrointestinal disorders, particularly diarrhoea (4).

These hospitalisations are considered to be avoidable in 7 to 67% of cases, depending on the authors (2). This seems to be explained in particular by the lack of availability of doctors or paramedics to identify or carry out the appropriate technical care or simple complementary examinations (5). During the night, the only staff present in these facilities are often orderlies who are less experienced in assessing emergencies. In a recent study, however, they were the ones who influenced the alert and decided to hospitalise in 40% of cases (6).

The value of specific channels for nursing home patients in reducing avoidable hospitalisations has been highlighted, by favouring short non-emergency channels, particularly for complementary examinations and technical care (7).

The possibility of having a rapid medical assessment on-site, a biological analysis within three hours or the implementation of intravenous hydration would avoid the systematic passage of patients residing in nursing homes through the emergency department. The value of advance directives notifying the non-resuscitation situations desired by the patient would make it possible to further reduce this figure (4).