NCHS Data Brief ■ No. 33 ■ April 2010

u.s. department of health and human services

Centers for Disease Control and Prevention

National Center for Health Statistics

Potentially Preventable Emergency Department Visits by 

Nursing Home Residents: United States, 2004

Christine Caffrey, Ph.D., Division of Health Care Statistics

Key findings 

Data from the National 

Nursing Home Survey, 2004

•	 In 2004, 8 percent of U.S. 

nursing home residents had an 

emergency department (ED) 

visit in the past 90 days. 

•	 Among nursing home 

residents with an ED visit in 

the past 90 days, 40 percent 

had a potentially preventable 

ED visit. 

•	 Injuries from falls were 

the most common conditions 

accounting for potentially 

preventable ED visits by nursing home residents.

•	 Nursing home residents 

who had a potentially preventable ED visit in the past 90 

days had shorter lengths of 

stay and more medications.

In 2004, there were over 110 million visits to EDs throughout the United 

States (1). Older adults, particularly nursing home residents, comprise a large 

and growing percentage of those visiting the ED (2,3). Prior research has 

identified conditions that may lead to potentially preventable visits to an ED

among nursing home residents (4–11). Fever, chest pain, heart disease (mainly heart failure), mental status changes, gastrointestinal bleeding, urinary 

tract infections, metabolic disturbances, pneumonia, diseases of the skin, and 

injuries due to falls have been identified as reasons for potentially preventable

visits to an ED. Researchers argue that some of these conditions, such as 

urinary tract infections, could be more appropriately treated in the nursing 

home. Other conditions prompting ED visits, such as those related to falls or 

pneumonia, may have been avoided by preventing the adverse health event 

itself. Decreasing potentially preventable visits to EDs may reduce health 

care costs, lessen trauma or complications resulting from medical treatment 

for nursing home residents, and improve quality of care. This report presents 

the only national information on potentially preventable ED use among U.S. 

nursing home residents.

Keywords: long-term care • emergency care • quality of care

Eight percent of nursing home residents had an ED visit in 

the past 90 days.

8% Any ED visit

123,600 residents

SOURCE: CDC/NCHS, National Nursing Home Survey, 2004.

Figure 1. Percentage of nursing home residents with an emergency department (ED) visit in the 

past 90 days, by number of visits: United States, 2004

15% 

Two or more

ED visits

18,400 residents

85%

One ED visit

104,900 residents

92%

No ED visit

1,354,300 residents
NCHS Data Brief ■ No. 33 ■ April 2010

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Eight percent of nursing home residents in 2004 had at least one ED visit in the past 90 days, 

representing 123,600 residents nationally (Figure 1). Of those nursing home residents with an ED 

visit in the past 90 days, 15 percent had two or more ED visits in that time period, representing 

18,400 residents nationally.

Among nursing home residents with an ED visit in the past 90 days, 40 

percent had a potentially preventable ED visit.

Among nursing home residents with an ED visit in the past 90 days, 40 percent had potentially 

preventable ED visits (Figure 2). Residents with a potentially preventable ED visit represented 3 

percent of all U.S. nursing home residents.

92% No ED visit

1,354,300 residents

8%

ED visit

123,600 residents 

60% ED visit

not potentially

preventable

73,300

residents

40% ED

visit potentially

preventable

50,300

residents

SOURCE: CDC/NCHS, National Nursing Home Survey, 2004.

Figure 2. Percentage of nursing home residents with a potentially preventable emergency department (ED) visit in the 

past 90 days: United States, 2004
NCHS Data Brief ■ No. 33 ■ April 2010

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Injuries from falls were the most common conditions accounting for 

potentially preventable ED visits by nursing home residents.

Injuries related to falls accounted for over one-third of the potentially preventable ED visits 

(Figure 3). Symptoms of heart conditions (mainly chest pain, pressure, burning, and heart failure) 

accounted for almost 20 percent and pneumonia for 12 percent of the potentially preventable ED 

visits. The remaining one-third included mental status changes, urinary tract infections, gastrointestinal bleeding symptoms, fever, metabolic disturbances, and skin diseases.

1

Other potentially preventable conditions included the following: fever, mental status changes, gastrointestinal bleeding, urinary tract infections, metabolic 

disturbances, and diseases of the skin. 

SOURCE: CDC/NCHS, National Nursing Home Survey, 2004.

Figure 3. Percent distribution of the conditions accounting for potentially preventable ED visits by nursing home residents 

in the past 90 days: United States, 2004

Other conditions1

Pneumonia

Heart conditions

Injuries from falls

33% 36%

19%

12%
NCHS Data Brief ■ No. 33 ■ April 2010

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Nursing home residents who had a potentially preventable ED visit in the 

past 90 days had shorter lengths of stay and more medications.

Among residents with potentially preventable ED visits in the past 90 days, 64 percent had a 

length of stay more than 6 months compared with 70 percent of all other nursing home residents; 

and 56 percent had nine or more medications compared with 50 percent of all other nursing home 

residents (see table). 

Table. Percentage of selected resident characteristics among nursing home residents with and without a 

potentially preventable ED visit: United States, 2004

Characteristic1 Residents with potentially 

preventable ED visit

Other nursing home residents

Length of stay more than 6 months 64 70

Taking nine or more medications 56 50

1

Differences are defined as statistically significant at p<.05.

SOURCE: CDC/NCHS, National Nursing Home Survey, 2004.
NCHS Data Brief ■ No. 33 ■ April 2010

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Summary

Overall, 8 percent of nursing home residents in 2004 had visited an ED in the past 90 days. A 

substantial percentage of those with an ED visit in the past 90 days had conditions that have been 

linked to potentially preventable visits. Injuries from falls were the most common conditions. 

Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter 

lengths of stay and more medications. This report identifies conditions and resident characteristics that nursing homes and policymakers might target to reduce preventable ED visits.

Definitions

Emergency Department Visits: Measured using a question that asked, “Since admission/In the 

past 90 days, has the selected resident had one or more hospital emergency department visits?” 

ED visit status was missing for 94 cases, representing 14,345 residents missing nationally. The 

question included the following probe, “Please include visits that occurred after the selected resident’s most recent admission to the nursing home.” Up to five visits were documented. Number

of ED visits was missing for two cases, representing 286 residents missing nationally.

Reason for Potentially Preventable Emergency Department Visits: defined by a response to the

following question, “What was the primary reason for the visit(s)?” It should be noted that the 

Reason for Visit Classification system was used to code these data rather than the International

Classification of Diseases, Ninth Revision codes (11). This study focused on the following conditions associated with potentially preventable emergency department visits and hospitalizations: 

general fever symptoms―includes high temperature (1010), general chest pain symptoms―

includes chest discomfort, pressure, tightness, and burning, and excludes heart pain (1050.1), 

heart disease symptoms―mainly congestive heart failure (2520), symptoms of mental status

changes―like mood swings, wandering around, disoriented, and noncommunicative (1165),

gastrointestinal bleeding symptoms―includes conditions such as blood in stool and vomiting

blood (1580), urinary tract infection symptoms (1675), metabolic disturbance diseases―includes

conditions such as low blood sugar, hypoglycemia, and poor nutrition (2215), pneumonia―such

as viral, bacterial, and broncho pneumonia (2630), diseases of the skin―includes conditions such

as cellulitis, seborrheic dandruff, eczema, psoriasis, and allergic skin reactions (2800–2899), and 

injuries due to falls (5810). 
NCHS Data Brief ■ No. 33 ■ April 2010

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Data source and methods

The 2004 National Nursing Home Survey (NNHS) data were used for these analyses. NNHS is a 

periodic cross-sectional survey of a nationally representative sample of U.S. nursing homes. It is 

designed to provide descriptive information on nursing homes, their services, their staff members, 

and the residents they serve.

The sample design for the 2004 NNHS was a stratified, multistage probability design. The first

stage was the selection of facilities and the second stage was the selection of residents. The 

primary sampling strata of facilities were defined by sampling bed size category and metropolitan

area status. For the 2004 NNHS, 1,500 nursing homes were selected using systematic statistical 

sampling with probability proportional to their bed sizes. The second stage sampling of current 

residents was carried out by the interviewers at the time of their visits to the facilities. The sampling frame for current residents was the total number of residents on the register of the facility 

as of midnight the day before the survey interview. A sample of up to 12 current residents per 

facility was selected, resulting in a total of 14,017 residents. The 2004 NNHS was administered 

using a computer-assisted personal interviewing (CAPI) system. Data were collected on facility 

characteristics and characteristics of the sampled residents.

Data analyses were performed using the statistical packages SAS version 9.1 (SAS Institute, 

Cary, N.C.) and SUDAAN version 9.0 (Research Triangle Institute, Research Triangle Park, 

N.C.).

About the author

Christine Caffrey is with the Centers for Disease Control and Prevention’s National Center for 

Health Statistics, Division of Health Care Statistics, Long-Term Care Statistics Branch. 
NCHS Data Brief ■ No. 33 ■ April 2010

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NCHS Data Brief ■ No. 33 ■ April 2010

Suggested citation

Caffrey C. Potentially preventable emergency department visits by nursing home 

residents: United States, 2004. NCHS data 

brief, no 33. Hyattsville, MD: National 

Center for Health Statistics. 2010.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

 Director for Science

Division of Health Care Statistics

Jane E. Sisk, Ph.D., Director

U.S. Department of

Health & Human Services

Centers for Disease Control and Prevention

National Center for Health Statistics

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