Emergency Care at Home

Emergency Care at Home: A Randomized Controlled Trial

This study will assess the efficacy of receiving emergency care at home versus in the brick-and-mortar emergency department.

Study Overview

• Status: Completed
• Conditions: Emergency Medical Services; Emergency Department Visits
• Intervention / Treatment: Other: Emergency care at a brick-and-mortar emergency department; Other: Emergency care at home

Detailed Description

Care in an emergency department has many benefits. It delivers high-intensity critical care on demand to large populations and serves as an efficient gateway to hospitalization. However, some populations may not be well-served by the traditional emergency department, particularly older adults, adults with serious illness, and those who are homebound. Many harms may come to older adults in the emergency department, including delirium, pressure injuries, infections, anxiety, and others. Emergency department crowding secondary to hospital capacity constraints may also lead to suboptimal care, as patients wait many hours for their inpatient bed even after a disposition decision is made.

As a result, the investigators will evaluate in a randomized controlled trial the efficacy of emergency care delivered at home instead of in the emergency department

• Study Type: Interventional
• Enrollment (Actual): 229
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age >= 18 years
• Resides within Home Hospital geographic area
• Lives in permanent housing (i.e., not in temporary housing such as a shelter)
• Patient of a Mass General Brigham primary care provider
• Primary care provider attests that their triage recommendation is the emergency department
• Emergency care at home nurse triages the participant to the emergency department or urgent care
• Patient attests that they intend to go to the emergency department

Exclusion Criteria:

• Insurance: workers compensation and motor vehicle accident
• Lives in a healthcare facility (Skilled Nursing, Rehab, long term acute care)
• Patient/caregiver cannot answer phone or door
• Active substance use
• Acute psychiatric concerns (e.g., suicidal ideation, even if passive)
• Home safety concerns (e.g., intimate partner violence)
• High-risk features:

oHigh Risk Signs, if available: Heart rate > 120 Systolic blood pressure < 90 Shock Index (heart rate divided by systolic blood pressure) > 1 Oxygen < 93% on ambient air Increase in oxygen requirement new or > 2 liters Respiratory rate > 28 Diaphoresis oHigh Risk Symptoms: Active chest pain Severe work of breathing Syncope Hemoptysis Seizure Other concerning symptom per nurse triage

• Requires inpatient-level care
• Requires specialty consultation
• Requires physical, occupational, or speech therapy
• Requires blood transfusion
• Requires internal physical exam maneuver (e.g. rectal exam, genitourinary exam)
• Requires imaging that is not available at home
• Requires monitoring that is not available at home
• Troubleshooting wound vacs

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Usual care; Emergency care in a brick-and-mortar emergency department.	Other: Emergency care at a brick-and-mortar emergency department; Standard emergency care delivered in a brick-and-mortar emergency department.
Experimental: Emergency care at home; Emergency care in the patient's home.	Other: Emergency care at home; A mobile integrated health paramedic under the direction of a remote emergency care physician will arrive at the patient's home and deliver emergency care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant with an emergency department presentation, observation, or hospitalization within 9 days	Whether a patient presented to the emergency department, was observed in the emergency department, or was hospitalized in the 9 days following their index emergency care visit. Excludes patients who were admitted on their index visit.	From the day after emergency care visit until 9 days later, up to 9 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to care initiation	Number of minutes from when the consultation for emergency care at home was placed to emergency care (either in the home or in the emergency department) occurs.	From the time a consultation is placed in the electronic health record to the time a patient is seen by a clinician, up to 2880 minutes.
Time spent receiving care	Number of minutes from when a patient was seen by a clinician to they are dismissed from the emergency room (usual care) or the paramedic leaves their home (experimental).	From the time a patient is seen by a clinician to the time a patient completes their emergency care, up to 1440 minutes.
Number of days at home within 9 days	The number of days the patient spends at home in the 9 days following the index emergency care visit.	From the day after emergency care visit until 9 days later

Collaborators and Investigators

• Sponsor: Brigham and Women's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 2, 2024
• Primary Completion (Actual): October 26, 2024
• Study Completion (Actual): October 26, 2024

Study Registration Dates

• First Submitted: February 26, 2024
• First Submitted That Met QC Criteria: March 7, 2024
• First Posted (Actual): March 8, 2024

Study Record Updates

• Last Update Posted (Actual): March 17, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2023P003383

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No