ED in the Home (EDITH)

Cliona Doyle, Ireland

Our Emergency Department (ED) sees over 60,000 annual attendances with 49% of these are aged 65 or over, and 14% are aged 75 or over. The hospital has a large mixed urban and rural catchment area with a high number of Nursing Homes within this.

The traditional model of emergency care involves patients being transferred to the ED to be assessed and this can be associated with elevated risks. We felt there was a clear need for our ED care to diversify in order to meet the needs of the service and for those attending it. Emergency Department in the Home (EDITH) responds to unscheduled care in an innovative way by assessing the patient in their home environment.

Emergency Department in the Home (EDITH) is a frailty response service, providing emergency medical and occupational therapy input to adults aged 65 and over in the hospital catchment area. EDITH was established to provide a patient-centred approach to emergency care, also with the aim of reducing unnecessary ED attendances. Subsequently, this would allow ED resources to be redistributed and to release bed days back into the healthcare system. EDITH runs as a seven day service with one Emergency doctor or Advanced Nurse Practitioner (ANP) and an Occupational Therapist on each shift.

EDITH accepts referrals from local General Practitioners (GPs), Nursing Homes, the National Ambulance Service (NAS), from local ED teams and other community-based health care. Referrals received can be related, but not limited to, falls, delirium, wound reviews, pain management, infections, functional decline or catheter-related issues. All accepted patients receive a once-off visit, however many patients will then be referred or sign-posted to relevant community services. So far we have seen over 5000 patients with the average conveyance rate to hospital of those seen under 10%.

There is a growing body of evidence highlighting the detrimental impact a hospitalisation can have on an older adult (Mudge et al, 2019). There is a clear need for health care services to diversify in order to meet the needs of this ageing population. EDITH is leading this change by providing specialised emergency care and Occupational Therapy intervention for the older adult in their own homes.