Presentation (CTI)

OBJECTIVES: Nursing home residents who turn acutely ill are sent to the nearest hospital’s emergency departments for further assessment and management. A large majority of them were admitted following the emergency department’s visit. An acute medical teleconsultation program operated by a regional hospital aims to reduce such hospital utilizations for nursing home residents in Singapore, especially if they are unnecessary. We aim to study the cost-effectiveness of the program.
METHODS: A cost-effectiveness analysis of the acute medical teleconsultation program for avoiding unplanned hospital utilisation was performed. A decision tree model simulated the clinical management pathways for acute medical conditions for nursing home residents using the program. The disposition of the teleconsultations and emergency department visits by nursing home residents for the year 2024 served as our clinical outcomes.
RESULTS: 855 emergency department visits were contributed by partnered nursing homes, in which 90.2% were admitted. 387 acute teleconsultations performed in 2024 resulting in 62.0% emergency department avoidance (n=240). From the perspective of the public healthcare institutions, encompassing the hospital and the emergency medical services, the acute medical teleconsultation model demonstrated incremental cost savings of 257.50 Singapore Dollars per unplanned hospital admission avoid, when compared with the usual care of sending to an emergency department of a public hospital. This amounted to a total of 66,178.58 Singapore Dollars in cost savings.
CONCLUSIONS: The acute medical teleconsultation program is a cost-saving model for avoiding unplanned hospital admissions for nursing home residents in Singapore. There is potential for adoption of this program across all public hospitals in Singapore.