Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.
‎A large proportion of hospital admissions, particularly for older adults, are made through emergency departments. Providing home-based care instead of admitting patients following an ED admission could help to avoid adverse events such as the contraction of hospital-acquired infections, delirium and falls. Research on emergency physicians' attitudes towards home-based care found that of 1,200 surveyed, 55 percent had ordered home-based care as an alternative to hospital admission in the prior 12 months, with the majority doing so less than once per month. Home-based care was considered a more optimum setting for low-acuity chronic or acute disease exacerbation scenarios. However, barriers to its provision included unsafe or unstable home environments. Conditions considered for home-based care included urinary tract infections, cellulitis, community-acquired pneumonia and diabetes. The authors conclude that: "providing home-based services is associated with better outcomes for patients, but it may also be associated with higher costs due to increased use of medical services, which can lead to greater health