Introduction: As the baby-boomer generation ages, the number of elderly patients with complex health issues visiting emergency departments (EDs) will continue to increase. Evidence suggests elderly patients often have better health outcomes if they can be managed at home with appropriate community and primary care supports in place, rather than being admitted to hospital. ED2Home is a program that launched March 1, 2016 in the Nanaimo Regional General Hospital (NRGH) ED. It aims to assess admitted patients aged 70 and over and discharge them with community supports and follow-up. The aim of this Quality Improvement project was to evaluate how many patients were successfully discharged by the ED2Home program in its first few months, and to characterize which patients were more likely to be successfully discharged versus bounce back to the ED. Methods: This Quality Improvement project audited the charts of 87 patients discharged by ED2Home from June-Sept 2016. Variables examined included the following: age, gender, chief complaint, mobility status, living situation, which ED2Home health care provider (RN vs MD) to facilitate discharge, whether patient had a family physician, and resources used (ex. pharmacy, physiotherapy, occupational therapy, etc.) to help facilitate discharge. Our evaluation was conducted by means of a retrospective chart review. Descriptive statistics were derived for variables of interest. Results: There were 87 patients discharged home by the ED2Home whose charts were reviewed. 48 (55%) of these patients were successfully discharged home without revisit to the NRGH ED within 30 days of discharge. 29 patients returned to the NRGH ED within 30 days of original discharge for the same original chief complaint. Patients successfully discharged were similar to those who bounced back in terms of gender and mean age. Patients who bounced back to the ED were more likely to have chief complaints of dyspnea and confusion compared to those successfully discharged. Patients who were successfully discharged had a higher proportion of patients with social admissions compared to those who bounced back to the ED within 30 days. A higher proportion of patients successfully discharged had been evaluated by the ED2Home physician (versus nursing alone) compared to patients who bounced back within 30 days. Conclusion: ED2Home appears to be successful at discharging patients and preventing revisit to the ED and re-hospitalization, similar to other transitional programs for the elderly that have been reviewed in the literature. Patients presenting with more complex issues, such as dyspnea and confusion, may not be as suitable for rapid discharge from the ED through this program as patients presenting with issues helped by additional allied health care supports, such as failure to thrive/social admission. Additional Quality Improvement iterations of the ED2Home program should be undertaken in the future, using these suggestions.
Developing A Hospital Specific and Evidence-Based Management Protocol for Pregnancies of Unknown Location and Ectopic Pregnancies: A Retrospective Chart Review and Quality Improvement Project
