An Overview of Options for Home-based Healthcare at the Emergency Department

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By Christopher Crowley, PhD, Program Manager and Amy Stuck, PhD, RN, Program Manager, Successful Aging, Gary and Mary West Health Institute

Editorial Note: The following overview was prepared in advance of a meeting hosted by the West Health Institute with a diverse group of healthcare leaders to develop a national action plan which enables more seniors to safely go home after an emergency room visit, rather than be admitted to the hospital. Experts and seniors themselves say home-based care can be a more effective way to treat patients with certain diagnoses, while helping lower the costs of healthcare. The West Health Institute is continuing to work with Urgent Matters on alternatives to admission at the ED. 

Executive Summary

Of the $2.9 trillion spent on healthcare in the U.S., inpatient medical care accounts for almost $1 trillion per year.  Today, more than 80% of unscheduled hospital admissions originate in the Emergency Department (ED), while Emergency Physicians (EPs) comprise only four percent of the physician workforce.  There is a growing appreciation that care initiated in the ED may too often trigger a subsequent “default” inpatient hospitalization, resulting in unnecessary cost and otherwise avoidable harm. The hazards of this scenario may be particularly pronounced in the aging adult population, where chronic disease is more prevalent and repeated hospitalizations increase the risk of delirium, nosocomial infections and falls. Presently, most EPs are generally afforded only three options following ED treatment: admit, discharge, or observe. However, early research suggests that the needs of older adults with multiple chronic conditions may be better met by providing more home-based care options. These options require innovations in technologies, policies and practices to better connect the ED with home-based skilled care as well as to physician oversight. The West Health Institute has formed a multidisciplinary external Advisory Council of leaders in healthcare to determine how best to amplify the appropriate use of emerging home-based care options for patients initially seen in the ED. Importantly, in addition to providing more efficient and effective alternatives to hospital-based care, developing more home-based options following ED evaluation could help establish infrastructure capable of better addressing a continuum of ongoing care needs, well beyond the timeframe immediately following ED treatment.