ER discharge criteria: homebound, disabled, cognitive impairment, bedridden/immobile, living in Tainan city/Yongkang (<30m drive). Exclude nursing home residents.
Since pioneering the establishment of our Geriatric Emergency Medicine Team in 2016, we have vertically integrated our emergency department, integrated medical wards, outpatient clinics, and home healthcare to deliver a comprehensive, one-stop continuum of care. To support elderly patients discharged from the emergency department, the team broke through traditional healthcare barriers by utilizing a smart information system to construct a dedicated referral platform and an advanced case management mechanism. Through tight, interdisciplinary collaboration among emergency medical staff, case managers, and home care teams, we ensure that vulnerable seniors can seamlessly transition back to their communities, receiving localized, continuous, and high-quality medical care right after leaving the emergency department.
Interdisciplinary collaboration to establish an effective case management mechanism.
Monthly team meetings to regularly track the outcomes of patient screenings and referrals.
Regular journal clubs to review domestic and international research for service optimization.
Smart information systems to facilitate home healthcare referrals for discharged emergency patients.
Dedicated case managers to oversee patient enrollment, care management, and follow-up.
Dedicated healthcare administrators to schedule home visits and maximize routing efficiency.
Instant LINE communication groups to provide online support and resolve patient/family inquiries.
Significant growth in monthly home healthcare enrollment.
Successfully increased the patient screening rate for home healthcare.
Successfully raised the successful referral rate for home healthcare patients.
Referral success rate for elderly ER patients: 47.3% by Our Team (vs. 15.4% in the US*)
3-day ER revisit rate for elderly patients: 3.0% by Our Team (vs. 8.64% in Taiwan/Asia*)
Successfully improved patient clinical outcomes and prognoses.
Patient screening rate for ER-to-home healthcare increased to 21.0%.
Referral success rate for ER-to-home healthcare increased to 47.3%.
3-day ER revisit rate for ER-to-home healthcare decreased from 4.0% (pre-intervention) to 1.7% (post-intervention).
Through interdisciplinary team interventions, patient prognoses were successfully improved. Furthermore, by providing comprehensive discharge health education, we effectively resolved ongoing caregiving challenges, resulting in an overall patient satisfaction rate of 94.6%.
The Chimei Geriatric Emergency Medicine Team published their home healthcare study, titled 'Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency department: a retrospective cohort study,' in the internationally renowned SCI journal, Aging Clinical and Experimental Research.
Featured in Global Views Monthly to demonstrate the social impact of our innovative medical model.
Invited for a keynote speech on home healthcare at the Taiwan Society of Emergency Medicine (TSEM) Annual Meeting.
Honored with the National Healthcare Quality Award in recognition of clinical excellence.
Attracted visits from major medical centers, maximizing our benchmarking and knowledge-sharing effects.
Pioneered the establishment of the Geriatric Emergency Care Subcommittee under the Taiwan Society of Emergency Medicine.
Assisted the Health Promotion Administration in compiling the national practical manual for geriatric emergency care.
