Experience of establishing an acute geriatric outreach service versus subacute service to nursing homes

Abstract

To share our experience of establishing an acute outreach service to nursing homes and to evaluate the impact of such service on emergency department presentations, data were drawn from a pre‐existing database from 2013 to 2017. Of the 986 acute patients treated in 12 nursing homes over a 23‐month period, the acute geriatric outreach service was shown to be safe, with few adverse events (one allergic reaction) and 5.3% of patients required transfer to hospital. The acute service decreased emergency department presentation of nursing home patients by 10% compared to the subacute service (incidence rate ratio = 0.90; 95% confidence interval: 0.84–0.96; P = 0.001). Cost–benefit analysis showed for every $1 spent, a saving of $5 was realised.

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

“…safety [46]. In Sweden, older adults expressed satisfaction when offered admittance to a geriatric ward instead of traditional conveyance to EDs when possible, due to previous negative experiences of ED admittance [41].…”

Impact of an acute geriatric outreach service to residential aged care facilities on hospital admissions

“…Previous feasibility studies of our acute service during the early days showed a 10.2% reduction in ED transfers from RACFs and an increased rate of discharge from ED for RACF residents (38.4% vs 52.5%, odds ratio=1.76, 95% CI 1.2–2.4, P <.001) compared to the SGOS period 11,13 . ITS analysis using unpublished data from those study periods found a statistically nonsignificant 26% reduction in the risk of admission from RACF.…”

“…Previous feasibility studies of our acute service during the early days showed a 10.2% reduction in ED transfers from RACFs and an increased rate of discharge from ED for RACF residents (38.4% vs 52.5%, odds ratio=1.76, 95% CI 1.2–2.4, P <.001) compared to the SGOS period. 11 , 13 ITS analysis using unpublished data from those study periods found a statistically nonsignificant 26% reduction in the risk of admission from RACF. The statistically significant larger effect size in our current study could be explained by the fact that our service has matured over time, with a stronger referral base and a bigger sample size with adequate power.…”

“…We have previously shown that there was a decrease in the number of ED presentations from RACFs after the introduction of the AGOS. 11 However, data available at the time (1 June 2013 to 30 April 2017) could only demonstrate a trend toward a reduction in geriatric department hospital admissions from RACFs, likely due to lack of power from available sample size.…”

Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta‐analysis

“…However, the second (strong-rated) medical and nursing initiative reported lower rates of hospital transfer/admissions (Fan et al, 2016), as did several similar services. These included two further strong-rated Australian geriatric outreach services (Chan et al, 2018;Hutchinson et al, 2015), and six moderate-rated US initiatives whereby embedded nurse practitioners provided direct patient care (Ingber et al, 2017;Rantz, Popejoy, et al, 2017). A Canadian study in which registered nurses visited care homes on predefined schedules also reported reduced ED transfers (Bandurchin et al, 2011*), but was deemed weak in quality.…”