Patient trajectories in a Norwegian unit of municipal emergency beds

Abstract

Objective: The Coordination reform was implemented in Norway from 2012, aiming at seamless patient trajectories. All municipalities are required to establish emergency care beds (MEBs) to avoid unnecessary hospital admissions. We aimed to examine occupancy rate, patient characteristics, diagnoses and discharge level of municipal care in a small MEB unit.

Design: Cross-sectional, observational study.

Setting: A two-bed emergency care unit.

Subjects: All patients admitted to the unit during one year.

Main outcome measures: Patients’ age and gender, comorbidity, main diagnoses and municipal care level on admission and discharge, diagnostic and therapeutic initiatives, occupancy rate.

Results: Sixty admissions were registered, with total bed occupancy 194 days, and an occupancy rate of 0.27. The patients (median age 83 years, 57% women) had mostly infections, musculoskeletal symptoms or undefined conditions. Some 48% of the stays exceeded three days and 43% of the patients were subsequently transferred to nursing homes or hospitals.

Conclusion: Occupancy rate was low. Patient selection was not according to national standards, and stays were longer. Many patients were transferred to nursing homes, indicating that the unit was an intermediate pathway or a short cut to institutional care. It is unclear whether the unit avoided hospital admissions.

Keywords:

• Emergencies
• intermediate care facilities
• primary care
• hospitals
• community
• Norway

Acknowledgements

The authors thank all nurses who have extracted data for this study from patients’ medical record. We acknowledge Kristian Jansen for English language editing.

Ethical approval

The Regional Committee for Medical and Health Research Ethics approved the study (REC West ref. 2014/1389).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Heidi Nilsen is a GP in Egersund, Norway. She is currently employed at Dalane District Psychiatric Centre. She is affiliated with the Research Group for General Practice in Bergen, Uni Research Health.

Steinar Hunskaar is research leader at The National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, and also a professor in general practice at the Department of Global Public Health and Primary Care, University of Bergen. He is an approved specialist in general practice.

Sabine Ruths is research leader at the Research Unit for General Practice in Bergen, Uni Research Health, and professor in elderly care medicine at the Department of Global Public Health and Primary Care, University of Bergen. She is approved specialist in general practice.

Additional information

Funding

This study was partly funded by a grant from the Norwegian Medical Association (AFU-grant 2014-2015).