Article Text

Download PDFPDF
  1. E Hartley1,
  2. J Holland2
  1. 1Emergency Department, University Hospitals Coventry and Warwickshire, Coventry, Warwickshire, UK
  2. 2City of Coventry Health Centre, Coventry and Warwickshire Partnership Trust, Coventry, UK


    Objectives & Background Many older patients present to ED after a fall. Older patients are more likely to get admitted to an acute bed when they present to the ED than younger patients. Admission is associated with loss of independence, acquired infections and delirium. Length of hospital stay is longer for older patients. Delayed discharge of medically well patients awaiting community care packages is associated with stagnant flow in the ED.

    We identified a population of older adults presenting via ambulance following a fall, who were being admitted for physio, OT and social worker assessment from the ED, but did not require inpatient treatment for a medical problem. We proposed that these admissions could be avoided.

    Methods Cross-sector admission avoidance initiative between primary and secondary care, ambulance services and social services in Coventry and Rugby area. Seamless 24/7 pathway developed to provide medical assessment, OT, physiotherapy, social support and emergency equipment to enable a patient to stay at home. We developed a traffic light based assessment system for ambulance crews, and resourced a 24 hour telephone line linked to an Advanced Nurse Practitioner and community care services. The ambulance crew refer to the ANP then get back on the road. The ANP can undertake a home visit to the patient, arrange a home visit from their GP or access an urgent GP appointment or appointments with the Falls clinic or Acute Medicine clinic. In addition to the medical assessment there is access to OT, physio and social care, including a fully stocked 24 hour equipment store.

    Results 174 referrals were made in the first 26 weeks of the pathway. 154 patients were enabled to stay at home.

    The admission avoidance rate was 88.5%.

    6/154 patients self-presented to the local ED within 48 hours of their urgent care intervention.

    There were 2 recorded clinical incidents.

    Patient feedback has been positive.

    Cumulative cost-savings in the first 26 weeks is £248000.

    Conclusion This cross-sector initiative has prevented admissions when the acute trust has been operating under significant bed pressure. This is an easy-to-use, patient centred, safe pathway giving comprehensive care to the fallen patient.

    For phase 2 we have developed an ED-based 'Pull-out Pathway' to enable the early discharge of fallen older patients following medical assessment in the ED. This will start in June 2015.

    • emergency departments

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.