345 Integration of care for older adults: an evaluation analysis of the clinical pathways from the emergency department

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Abstract Background There is an urgency globally to create novel healthcare models for the older adult population considering the ever-growing demographic. Ireland’s Integrated Care Programme for Older People (2016) emphasises the importance of delivering healthcare to older adults in their community with focus on the direct access to services from the Emergency Department (ED). This ‘frailty at the front door’ team sought to evaluate the clinical pathways facilitating direct integration of care into the community following completion of the Comprehensive Older Adult Assessment (COAA) in the ED of a model 3 hospital. Methods The team conducted an evaluation analysis of the critical pathways referring patients to the community directly from the ED. The team recorded the quantity of referrals to each community service on discharge over a period of six months from October 2022–March 2023. This included Health Services Executive (HSE) services and voluntary sector services. The results included admission avoidance pathways. The team completed a case study review for individuals readmitting to the ED within 7 days and 30 days. Results 796 Older Adults were assessed by the team in the ED. 368 Older Adults were discharged directly to the community. From January–March 2023 there were 79 admissions avoided. For those discharged, there were 440 onward referrals made to community-based services. These included 91 referrals to Primary Care Physiotherapy, 83 to Public Health Nurse, 60 to Primary Care OT, 45 to the Community Intervention Team, and 11 referrals to the Dementia Advisor. The 7 day readmission rate ranged from 0–4% per month. The 30 day readmission rate ranged from 5–13%. Conclusion There was a high level of integration of care between the ED ‘frailty at the front door’ team and voluntary or HSE community services. The low readmission rate demonstrates the effectiveness of the discharge pathways in enhancing the safety of discharges.