Perspectives on Home-based Healthcare as an alternative to Hospital Admission After Emergency Treatment

Authors include: Amy R. Stuck, RN, PhD, Christopher Crowley, PhD; (both of West Health); Tracy Martinez, RN; Alan C. Wittgrove, MD; Jesse J. Brennan, MA; Theodore C. Chan, MD and Edward M. Castillo, PhD, MPH.

Section Editor: David Thompson, MD
Submission history: Submitted September 7, 2016; Revision received March 30, 2017; Accepted March 25, 2017
Electronically published May 15, 2017
Full text available through open access at
DOI: 10.5811/westjem.2017.3.32348


The study objective was to explore emergency physicians’ (EP) awareness, willingness,
and prior experience regarding transitioning patients to home-based healthcare following emergency
department (ED) evaluation and treatment; and to explore patient selection criteria, processes, and
services that would facilitate use of home-based healthcare as an alternative to hospitalization.

Methods: We provided a five-question survey to 52 EPs, gauging previous experience referring
patients to home-based healthcare, patient selection, and motivators and challenges when
considering home-based options as an alternative to admission. In addition, we conducted three
focus groups and four interviews.

Results: Of participating EPs, 92% completed the survey, 38% reported ordering home-based
healthcare from the ED as an alternative to admission, 90% ranked cellulitis among the top three
medical conditions for home-based healthcare, 90% ranked “reduce unnecessary hospitalizations
and observation stays” among their top three perceived motivators for using home-based care,
and 77% ranked “no existing process in place to refer to home-based care” among their top
three perceived barriers. Focus group and interview themes included the need for alternatives to
admission; the longer-term benefits of home-based healthcare; the need for streamlined transition
processes; and the need for highly qualified home-care staff capable of responding the same day or
within 24 hours.

Conclusion: The study found that EPs are receptive to referring patients for home-based healthcare
following ED treatment and believe people with certain diagnoses are likely to benefit, with the dominant
barrier being the absence of an efficient referral process. [West J Emerg Med. 20XX;XX(X)XX-XX.]

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