Value-based care of older people—The impact of an acute outreach service unit on emergency medical service missions: A quasi-experimental study

Abstract

Background: Transfers to the emergency department can be burdensome for the residents of long-term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse-led acute outreach service unit “Mobile hospital” (in Finnish, Liikkuva sairaala, LiiSa) has been providing on-site care to LTRCF residents to reduce transfers to the emergency department. Methods: This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six-month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A–D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. Results: Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%–22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%–30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%–41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. Conclusions: LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs.