Abstract
Background: The EDITH team has provided an alternative care pathway for older adults in need of emergency services. The traditional model, which involved the transport of an older adult to an emergency department, has been replaced with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation. This pioneering service has been operational for almost three years and has become a successful example of right time, right place and right care for the older adult.
Method: Data from electronic patient records and OT logbooks was audited from the period 22/02/20 to 30/11/23. Data was gathered regarding attendances, outcomes and conveyance rates.
Results: Since its’ conception the EDITH service has treated 8650 patients. Following assessment 7930 patients remained at home while 720 patients were transferred to hospitals. This gives a conveyance rate of 8.3%. The EDITH service has saved the hospital 21.72 years of bed days by providing these patients with alternatives to admission. The cost savings to the hospital are estimated to be 6,737,950 euro (7927 bed days X 850 euro-average cost per bed day). Patient acuity ranges from a Manchester Triage Scale of category 2 to 5 with the average being category 4. The EDITH service has developed pathways for direct admissions to off site rehabilitation settings, respite, day hospital and community reablement teams.
Conclusion: 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. The EDITH service provides specialized geriatric emergency care in the patients’ own home which gives an opportunity for family members to be present and for the patient to be reviewed within the context of their own familiar surroundings. It allows for OT assessment to be completed in context, with equipment provision and installation being completed in real time. It results in a most favorable and comfortable experience for the patient as they do not need to attend a busy emergency department. It also reduces the number of older adult attendances to the emergency department thus allowing for resources to be reconfigured to attend other emergency presentations. The EDITH service is now a valuable and integral part of emergency care and is leading this change in Irish healthcare by providing specialised emergency care and OT intervention for the older adult in their own homes.
Reference: Mudge et al (2019). Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. Journal of the American Geriatrics Society. 67(2)