The new service model was established on 1st November 2020 at the ED of the Odense University Hospital (OUH), Denmark, in collaboration with Odense Municipality and the EMDC. This new service is activated if a nursing home calls the EMDC for emergency assistance. Based on the perceived urgency of the task, the EMDC dispatches either the ED consultant alone or in conjunction with an ambulance or anaesthesiologist-manned mobile emergency care unit that is already operating in the area [17 (link), 18 (link)]. At the nursing home, the ED consultant provides on-site emergency evaluation and treatment using point-of-care blood testing and ultrasonographic examinations. This treatment includes intravenous fluids, antibiotics and relevant medications. Furthermore, the ED consultant assists in drawing up future treatment plans, including the issue of do-not-resuscitate orders. Following the initial treatment offered by the ED-based service, the residents can either remain in the nursing home or be transported to a hospital depending on what is most applicable to the residents’ goals of care. At the nursing homes, the ED consultants collaborate with municipal acute care nurses (who are specialised in delivering acute nursing services at home) [17–19 (link)], the nursing home staff, the residents and their relatives.
In the first month, the service operated 24/7 as an initial test run. Since then, the service was restricted to weekdays between 8 am and 4 pm (Figure 1). The municipal acute care nurses were referred to all tasks in the first month of implementation. However, after 6 months, they were only requested if specifically required, such as if the resident required intravenous (IV) treatment. The changes in the complex trans-sectorial model were based on organisational possibilities, including the access to resources and they were influenced by changes in regional guidelines. In the two last time periods, the care had to be initiated and finished during one visit by the ED consultants unless otherwise agreed with the municipal acute care nurses.