Bridging Hospital and Nursing Home: Collaboration for Smoother Transitions and Reduced Hospitalizations.

The exigencies of managing acutely ill residents within nursing homes have led to an increase in ambulance conveyances to the emergency department. This is further compounded by a shortage of adequately trained nursing staff and on-site physicians available around the clock. An acute regional hospital, strategically located in the epicenter of nursing home facilities in Singapore, encountered this challenge on its inception in 2018 within the northeast region. In response, the institution initiated a collaboration, EAGLEcareACT (Enhancing Advance Care Planning, Geriatrics, and End-of-Life Care Acute Care Team), aimed at rectifying the prevailing care disparities between neighboring nursing homes and the hospital. Within the EAGLEcareACT, a systematic and comprehensive approach was undertaken to engage diverse nursing homes, delineate precise needs, and establish mutually shared objectives. This encompassed the provisioning of monitoring of patients treated for acute medical conditions, structured training programs for nursing staff and aids in advance care planning. Teleconsultations with EAGLEcareACT team obviate the immediate necessity for conveyance to the emergency department.

Integrated care at the emergency department: an investment for better health.

It is crucial that policy makers, healthcare providers and relevant stakeholders understand how integrated care may be improved at our emergency departments (EDs) and what benefits that would bring. The potential that exists for right-siting care of special patient groups who could be managed in an ambulatory setting with the integration of a variety of hospital-based and community-based clinical support services is tremendous. This review describes the best practice and value of integrated care at the EDs. Local evidence is cited and compared with findings from overseas. The opportunities of care transition interventions among discharged patients are outlined, including that for paediatric patients, palliative care patients and patients with chronic diseases. This review also suggests ways to move forward to meet the aim of providing holistic care at EDs through integrated care programmes, innovation and research.