Claus-Henrik Rasmussen, Nina Andersen, Søren Mikkelsen, Mikkel Brabrand, Annmarie Lassen
As an alternative to ambulance transport to the Emergency Department (ED) and in-hospital evaluation and treatment, we thought it would be possible to conduct acute evaluation and treatment on site in the nursing home. In our service model this is completed by a trained emergency physician from the local ED in collaboration with a high qualified acute team nurses from the local municipality and can provide an alternative to hospitalization.
On weekdays between 8.00 and 16.00 all emergency ambulance activations involving nursing home residents in the Odense Municipality, simultaneously activate a request to attend by a senior doctor in the ED Odense University Hospital and the municipality acute nursing team.
The ED doctor evaluates the patient (and can complete point of care blood testing and ultrasound as well as physical examination). They then start treatment, including fluid and antibiotic if needed, in collaboration with the professional team (ambulance personnel, municipality acute nurses and nursing home personnel) as well as with the patients and relatives. The patient can remain in their nursing home or can be transported to hospital depending on what best suits the patients goals of care.
In our area, the Odense Municipality we have 24 nursing homes with 1284 residents. Between 1st of December 2020 and 9th of April 2021, we completed 251 contacts, corresponding to 2.6/day on weekdays and 5/100 nursing home residents per month. Among all patients 169 (67%) had POCT analysis performed, 179(69%) acute ultrasound, 223 (92%) of all patients were treated in the nursing home and did not immediate need hospitalization. The one-month hospitalization rate was 16%, one-month mortality was 32%.
We feel that an ED physician-based service for acute sick nursing home residences can provide onsite acute evaluation and treatment for over 90% of the acutely ill nursing home patients who otherwise would have been transported to the hospital and treated there. This project successfully demonstrates that it is possible to move the expertise of the ED to vulnerable nursing home residents.