Avoiding Emergency Department Attendance After a Fall: Emergency Department in the Home Case Study

Background

The Emergency Department in the Home (EDITH) service provides an alternative to Emergency Department (ED) attendance for older adults by delivering acute emergency care in the person’s home. The service aims to support admission avoidance while promoting safety and functional independence through a multidisciplinary approach, including medical and Occupational Therapy (OT) assessment. Falls in older adults account for approximately 22% of EDITH referrals per month in 2025. Nationally, the cost of fall-related injuries in older adults in Ireland is projected to exceed €2 billion by 2030 (Health Service Executive, 2025). This abstract presents a case study highlighting the role of EDITH in the assessment and management of a fall in an older adult, avoiding an ED attendance.

Methods

A case study methodology was used to examine the assessment and management of an older adult referred to the EDITH service following a fall at home. The referral was initiated by the National Ambulance Service following a lift and assist, with no injuries identified at the scene. Same-day clinical and functional assessments were completed. Data was gathered through direct patient assessment and review of the EDITH electronic clinical notes system, including medical and OT documentation. 

Results

Assessment focused on an 82 year old female exploring the cause of fall, exclusion of acute injury, functional status, falls risk factors, home environment, and available supports. Medical assessment, including observation levels and a head-to-toe exam, indicated that the patient was medically stable. OT assessment identified the patient lives alone with no formal supports, increased dependency with transfers and personal care post fall, nil pendant alarm in place. Immediate interventions included environmental modifications, provision of compensatory equipment, falls prevention education including pendant alarm information. Onward referrals to community services such as public health nurse was arranged, and ED attendance was avoided. 

Conclusion

This case study demonstrates the effectiveness of the EDITH service in managing falls in older adults through timely, multidisciplinary intervention to avoid hospital attendance. Early involvement within a community based emergency care model supports admission avoidance, addresses modifiable falls risk factors, and enhances patient experience. Thus, EDITH represents person centred approach aiming to reduce the clinical and economic burden of falls in Ireland’s ageing population.

References

Health Service Executive. (2025). Falls prevention framework. https://www.hse.ie/eng/services/publications/falls-prevention-framework.pdf