Aims: To describe patients, care provided and hospital avoidance outcomes of a new EHITH model of care.
Methods: EHITH attended acutely unwell older patients across a metropolitan Sydney health district. Descriptive cross-sectional and retrospective follow-up data including comprehensive geriatric assessment, investigations, diagnosis, EHITH treatment and onward referral was collected in a dedicated REDCap database. Twenty-eight-day emergency/Hospital admissions were determined through retrospective review of electronic medical records.
Results: Total 793 patients were seen over 19 months: 55% female, median age = 84 years (IQR 76-90). 71.8% lived at home, 39.7% without carer support, 75% frail (Clinical Frailty Scale ≥ 5) and 38% cognitively impaired. Referral sources were paramedics (36%), Residential Aged Care Outreach (16%) and general practitioners (7%). Referral reasons were: being generally unwell (24.5%), pain (11.6%), infection (12.9%) and wounds (12%). Decision-making was supported through point-of-care blood tests (19.8%), laboratory tests (72.3%) and mobile imaging (25.7%). Medications were altered for 484 (61.3%) patients and 183 (23.1%) patients received intravenous therapy. Main onward referrals were to Hospital in the Home (165; 20.8%), allied health (89, 10%) and other community services. Median visit time was 60 minutes (IQR 45-75).
Without EHITH being available, 486 (78.6%) of 618 referrers would have sent the patient to Emergency. 716 (90.2%) patients avoided immediate hospital presentation or admission, and 459 (57.9%) over the subsequent 28 days.
Conclusions: Acutely unwell older people were comprehensively assessed and managed by EHITH without requiring hospital presentation. Age, frailty and investigations did not preclude urgent assessment and management at home.