Introduction: We reviewed data for Antrim Emergency Department (ED) attendances from nursing and residential homes. Over 22 months (April 2009–January 2011) there were 3,604 attendances, averaging 5.4 per day. Forty-eight percent attended out-of-hours. Sixty-four percent in total were admitted. We introduced outreach clinics into nursing homes in the Northern Trust. The primary aims were to ensure healthy residents and prevent unnecessary hospital admissions.
Innovation: Each nursing home would be reviewed; homes with the most ED admissions were selected first. Weekly clinics were attended by a Consultant Geriatrician, Consultant Pharmacist and nursing home staff. Each resident's case notes were studied, their care discussed and medication charts reviewed. Residents with unstable chronic disease, high risk medications, recent or frequent ED attendances and a history of falls were prioritised first.
Evaluation: Four nursing homes have been evaluated so far. Our results are in the table below.
Conclusions: We have reduced ED attendances and hospital admissions. Engagement from nursing home staff was vital and may explain nursing home 2 results. Feedback was positive regarding confidence and support in managing residents. We discussed advanced care planning for a number of residents, preventing future inappropriate hospital admissions. A cost-benefit analysis is available for nursing home 1. Reduction in ED attendances and hospital admissions saved the Trust £15,802. The series of six clinics cost £4,690, a net saving of £11,112. Outreach clinics have expanded with four Geriatric Consultants and four clinics weekly. Four clinics running weekly could save £222,244 per year.