Aims. Determine the proportion not seen in emergency departments (ED) at Days 1, 7, 28 and 90 after seen by Emergency Hospital in the Home (EHITH), a novel community service managing urgent, low-acuity conditions in older, frail adults.
Methods. Prospective cohort design. Dedicated database captured demographic and clinical data. ED presentations determined by data linkage/electronic records. Referrers predicted disposition if EHITH unavailable and Sydney Triage and Admission Risk Tool (START) estimated likelihood of requiring admission had patients attended ED instead.
Results. 687 patients seen March 2023- October 2024, majority referred by Ambulance paramedics (240, 35%) and residential care outreach (128, 19%). Patients were older (median age 84; IQR 76-90) and frail (411; 60%). Primary reasons for referral: general unwellness (254, 37%) and non-cardiac pain (106, 15%). Intervention included X-ray (198, 30%), medication cessation (118, 17%), medication commencement (431, 63%), IV antibiotics (177, 26%), IV diuresis (50, 7%) and IV hydration (68, 10%). 143 (21%) referred to Hospital in the Home. 612 (89%), 493 (72%), 419 (69%) and 357 (52%) EHITH patients did not present to ED at day 1, 7, 28 and 90 respectively. Most referrers (86%) would have sent the patient to ED if EHITH unavailable. START predicted 85% were very likely/likely to require hospital admission if presenting to ED. Mortality at Day 1, 7, 28 and 90 was 0.6%, 3.1%, 9.3% and 16%, respectively.
Conclusion. The EHITH model of care provides effective and safe care to older people with urgent medical problems at their place of residence.