Emergency department-based home care.
OBJECTIVE
To assess the feasibility of coordinating home care services from an inner-city emergency department.


METHODS
In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status.


METHODS
Teaching hospital serving a large indigent population.


METHODS
Adult patients about to be discharged home from the ED.


RESULTS
Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program.


CONCLUSIONS
A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.
Brookoff
D
D
University of Tennessee College of Medicine, Memphis.
Minniti-Hill
M
M
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000458:organization & administration*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007373:Interinstitutional Relations; D008297:Male; D008489:Medical Indigency; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D012017:Referral and Consultation / Q000458:organization & administration*