Evaluating a new emergency department avoidance service for older people: patient and relative experiences.
Emergency Medicine Journal · 2023-07-03 · Qualitative study
Abstract
BACKGROUND: High emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged 65 and above, the Southern Adelaide Local Health Network introduced an innovative ED avoidance service. This study assessed the acceptability of the service among its users. METHOD: The Complex And RestorativE (CARE) Centre is a six-bed unit staffed by a multidisciplinary geriatric team. Patients are transported directly to CARE after calling for an ambulance and being triaged by a paramedic. The evaluation took place between September 2021 and September 2022. Semi-structured interviews were conducted with patients and relatives who had accessed the service. Data analysis was performed using a six-step thematic analysis. RESULTS: Seventeen patients and 15 relatives were interviewed, who described the experience of 32 attendances to the urgent CARE centre between them. Patients accessed the service for several reasons but over half were associated with falls. There was a hesitation to call emergency services for several reasons, the primary being long wait times in ED and/or the prospect of an overnight stay in hospital. Some individuals attempted to contact their General Practitioner (GP) for the presenting problem but were unable to get a timely appointment. Most participants had previously attended a local ED and had a negative experience. All individuals reported favouring the CARE centre over the traditional ED for numerous reasons including a quieter and safer environment and specially trained geriatric staff who were less rushed than ED staff. Several participants would have appreciated a standardised follow-up process after discharge. CONCLUSION: Our findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Older adults · Paramedics & EMTs · Patient experience
Related articles
- Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial. (Ann Emerg Med, 2017)
- Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. (Health Technol Assess, 2017)
- Innovative Use of Emergency Medicine Providers in an Urban Setting to Reduce Overutilization of 9-1-1. (J Emerg Med, 2020)
- The effect of a quality improvement feedback loop on paramedic-initiated nontransport of elderly patients. (Prehosp Emerg Care, 2002)
- Could low-acuity emergency medical services patients be redirected to primary care? Findings from a multi-center survey in Berlin, Germany. (BMC Emerg Med, 2025)
- Outcomes of adult patients discharged at scene by emergency medical services. (Emerg Med J, 2024)