Enhancing Patient Care Through Outreach Visits from Emergency Department
Providing outreach visits directly from the Emergency Department to patients seen by the Frailty Intervention Therapy Team has proven effective in facilitating timely therapy reviews, reducing unnecessary admissions, and ensuring safer discharges. The initiative targets patients at high risk of hospital admission due to falls, delirium, or dementia, offering services like equipment provision, mobility reviews, and therapy in the patients' own environment. Over a 10-month period, the outreach visits resulted in improved patient outcomes, with a significant decrease in representations within 7 days of discharge. The sustained impact of the program highlights its value in enhancing patient-centered care and preventing complications associated with frailty in older adults.
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Presentation Transcript
Assessing the effectiveness of an Outreach Visit Pathway direct from ED for patients seen by the Frailty Intervention Therapy Team Name: Kara Mc Loughlin, Carol Lyons, Louise McGettigan, Paul Maloney Department: Frailty Intervention Therapy Team, Emergency Department Hospital: Beaumont Hospital @fittbeaumont
Aim Background To identify appropriate FITT patients to provide an Outreach visit from ED within 72 hours of discharge pending needs. This service was in conjunction with the existing Integrated Care Teams/ community services but an outreach visit direct from ED may have been indicated due to; staffing levels, response time, catchment area or existing rapport with the individual patient. Falls are a leading cause of presentation to the Emergency Department for older adults. They often are at high risk of admission to hospital following a presentation to ED which can lead to other complications of frailty such as development of delirium or deconditioning. The risks of admission were further complicated in the past year due to COVID and it s adverse outcomes on our older frail population which further highlighted the need to manage their needs at home where possible. Change initiative FITT identified appropriate patients from the ED to complete outreach visits for the following reasons; Recurrent falls with potential environmental causes Unresolved delirium/advanced dementia with ongoing therapy needs/one off visits for education/functional review in their own environment Bridging gap while awaiting community teams Assessment for & fitting of therapy equipment Demonstration of safe moving & handling techniques to patient/family/carers
Results What worked well Over 10 months, August 2020-June 2021 The provision of an outreach services allowed a swift therapy review in the patient s own home & onwards referrals as indicated. 34 outreach visits completed Average CFS: 6 Often these patients were likely to be admitted however the outreach provided a safety net to facilitate direct discharge from the ED with no representations within the first 7 days. Reasons for: 12 for safety checks 15 equipment provision/fitting 6 mobility reviews Onward referrals: 22 (PCCC OT, Physio, PHN & day hospital & ICT) Represent within 7 days = 0 Represent within 30 day = 14 (41%)
Sustained- how was the improvement sustained Value to patients Outreach visits are now a key role we provide in our service to allow safer discharges from the emergency department & prevent unnecessary admissions The provision of an outreach service has allowed patients and their family the ability to return home following presentation to the Emergency Department and provides them with the security of a multidisciplinary assessment in their own environment
