Immobilität als Grund der Vorstellung in einer Krankenhausnotaufnahme? Eine retrospektive Analyse ambulanter Patienten aus zwei Zentren

Background: Emergency departments (ED) are increasingly challenged by large numbers of low-acuity patients. This may be due to wrong incentives or structural shortcomings in other areas of medical care. Methods: Retrospective analysis of a random sample of patients of the EDs of two metropolitan hospitals. We characterized patients who were discharged from ED but were dependent on ambulance services (AS) to be taken back home. Results: Of a total of 80,854 cases, 1500 patients (767 [51.1%] women; age 56 ± 22.7 years) were analyzed: 888 (59.2%) were treated as out-patients. 9 (0.5%), 193 (12.9%), 684 (45.6%), 508 (33.9%) and 48 (3.2%), respectively, were triaged as categories red, orange, yellow, green and blue according to Manchester Triages System. Of 880 patients, discharged from ED, 731 (83.2%) returned home autonomously and 149 (16.8%) with an AS. More than half presented with urological problems, extremity problems and after falls. Out-patients dependent on AS were older (76.2 ± 16.2 vs. 45.1 ± 20.5 years; p < 0.001), more polymorbid (Charlson Comorbidity Index: 5 [3–6] vs. 0 [0–2]; p < 0.001), required computed tomography (CT) imaging less often and more often only had a simple medical intervention with no diagnostic workup (24.8% vs. 4.6%; p < 0.001). Larger proportions presented repeatedly (28.9% vs. 8.5%; p < 0.001) and were nursing home residents (59.5% vs. 0%; p < 0.001). Conclusion: Every tenth patient seen in ED was discharged with an AS. More than half were transferred from nursing homes. A large part of these received only simple medical interventions, almost no diagnostic interventions and had a low triage acuity.