EMERGENCY DEPARTMENT-BASED HOME CARE

Study objective: To assess the feasibility of coordinating home care s ervices from an inner-city emergency department. Intervention: In a pr eintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who a rranged and managed rapidly deployed home care services then was assig ned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. Setting: Teachi ng hospital serving a large indigent population. Participants: Adult p atients about to be discharged home from the ED. Main results: Forty-f ive of 650 (7%) surveyed patients were not receiving home care service s 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 availibility of rapidly deployed home care services obviated the need for emergency admission to the h ospital. Net billings to third-party payers exceeded the costs of the program. Conclusion: A significant proportion of elderly patients bein g discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admissio n for a select group of debilitated patients. The provision of home ca re services from the ED is economically feasible.