title: In-reach nursing services improve older patient outcomes and access to emergency care.
abstract: OBJECTIVE
  To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care.
  
  
  METHODS
  Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services.
  
  
  RESULTS
  Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007).
  
  
  CONCLUSIONS
  There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.
authors.affiliation: Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia.|Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia.
authors.forename: Maryann
authors.identifier: http://orcid.org/0000-0002-5615-141X
authors.initials: M
authors.lastname: Street
authors.affiliation: Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia.|Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia.|Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Livingston
authors.affiliation: Deakin University, School of Nursing and Midwifery, Burwood, Victoria, Australia.|Uniting Care Community Options, Glen Waverley, Victoria, Australia.
authors.forename: Goetz
authors.initials: G
authors.lastname: Ottmann
authors.affiliation: School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.
authors.forename: Bridie
authors.initials: B
authors.lastname: Kent
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005851:Geriatric Nursing / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006707:Homes for the Aged / Q000458:organization & administration; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D010166:Palliative Care; D010343:Patient Admission; D010351:Patient Discharge; D010360:Patient Transfer / Q000458:organization & administration; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors; D014739:Victoria
keywords: aged; emergency medicine; health services access; health-care reform; nursing home; older person