Telemedicine Bridge Between EDs and NHs: Reducing NH Residents’ Avoidable Emergency Visits

TL;DR

A telemedicine program connecting hospital EDs with nursing homes helps reduce avoidable emergency visits by better managing non-urgent cases.

Contribution

The study evaluates a novel telemedicine program's impact on reducing avoidable ED visits among nursing home residents.

Findings

Residents from partnered nursing homes had higher odds of hospitalization and critical condition scores.

Telemedicine helped identify high-risk patients requiring ED care while managing non-urgent cases at nursing homes.

The program was associated with increased ED acuity levels among nursing home residents.

Abstract

Nursing Home (NH) residents have high rates of emergency department (ED) visits, with nearly half potentially avoidable. We evaluated the impact of the EAGLEcareACT (Enhancing Advance Care Planning, Geriatrics, and End-of-Life Care Acute Care Team) --an interdisciplinary telemedicine program at Sengkang General Hospital (SKH), Singapore linking ED physicians with NH staff—on reducing avoidable ED visits among NHs residents. Between 2020-2023, 7 out of the 35 NHs in the catchment area were enrolled in EAGLEcareACT. We analyzed data from all ED visits at SKH from NHs residents 2020-2023. Outcomes included hospitalization, National Early Warning Score (NEWS), and ED acuity levels. We used generalized estimating equations models, to assess associations between EAGLEcareACT enrollment and outcomes accounting for within-NH clustering. Among 6,344 ED visits from NH residents (median age 78 years, 37.8% female, 85.8% Chinese), 2,483 (39.1%) were from EAGLEcareACT partnered NHs. Patients from partnered NHs were slightly older (median 79 vs. 78 years) and more likely to be female (43.4% vs. 34.2%) than patients from non-partnered NHs. After adjustment, comparing to patients from non-partners NHs, those from partnered NHs were more likely to be hospitalized (odds ratio [OR] 1.59, 95% CI 1.10-2.29), have a critical condition as NEWS scores ≥5 (OR 1.76, 95% CI 1.27-2.45), and present with high acuity (OR 1.69, 95% CI 1.15-2.50). These findings suggest that EAGLEcareACT effectively manages non-urgent cases at NHs via telemedicine while appropriately identifying high-risk older adults requiring ED care. Further research is needed to evaluate long-term outcomes and healthcare utilization impacts.