291 The Impact of a Frailty Team Liaison Service on Nursing Home Attendances in an Emergency Department

Abstract

Abstract Background Up to 50% of referrals from nursing homes to emergency departments (ED) are considered inappropriate. Interventions such as the introduction of advanced practice registered nurses to nursing homes, and community matrons in other jurisdictions have reduced inappropriate referrals. Methods A liaison service with nursing homes was initiated by a candidate Advanced Nurse Practitioner (cANP) supported by the frailty multidisciplinary team in January 2019. It focused on nursing home residents aged 70 years and older. A single point of contact was provided. ED presentations were assessed if possible, and telephone consultations were also available. A database was maintained and the data from the first 3 months of this service was analysed. Results The service provided from 7th January and 31st March 2019 was studied. Referrals of patients aged 70 years and over from nursing homes to ED for this period in 2018 were 100. In 2019 it was 73, representing a 27% decrease in referrals. The total number of patients referred in 2019 was 51. Twenty one (41%) patients had an assessment by the cANP. Interventions by the cANP and team included rapid access to other specialties, medication reconciliation, and prescription of antibiotics, diagnostics and referral to the Community Intervention Team (CIT). Telephone liaison from nursing homes resulted in referrals to the palliative care service in 2 cases, prescription of antibiotic in another, rapid access comprehensive geriatric assessment in another case and rapid access to ED for catheter change in another, hence admission avoidance's in all of these cases. Conclusion The early experience of this service is that it facilitated more nursing home residents to receive care and support within their care setting. It contributed to reduced referrals of this vulnerable cohort of the population to ED, and also resulted in admission avoidance in some cases.