Actions taken to decrease the amount of unnecessary emergency service visits by the elderly in the Helsinki Metropolitan Area

Helsinki Metropolitan Area and HUS audit measures were implemented to assess whether the aim to treat a larger proportion of elderly patients’ acute cases via institutional care, service housing care or at-home care instead of emergency care had been reached. The conclusions of this assessment were that the cities and HUS had worked towards this goal by implementing guidelines, methods and services that specifically aim to decrease the amount of emergency service visits by the elderly. Due to the coronavirus pandemic and insufficient statistical data, the impact of these measures on prehospital emergency care and emergency service visit numbers could not be assessed. In Espoo, the Mobile Hospital LiiSa service has had a role in pushing long-term care-related emergency service visit numbers down.

The assessment considered at-home care, service housing care and institutional care provided in the cities of Espoo, Helsinki, Kauniainen and Vantaa. In the case of HUS, the assessment considered the current state of elderly patients’ emergency care situations and the actions taken to develop the operating models used by HUS and the municipalities in patient discharging and follow-up care. For this assessment, an elderly patient was defined as any person above the age of 75.

Coronavirus pandemic likely to have affected prehospital emergency care numbers

In all the assessed cities, when compared to the previous year, prehospital emergency care visits decreased in 2020 and increased in 2021. These changes are likely to have been caused by the coronavirus pandemic. The decrease in the number of prehospital emergency care visits observed in Espoo during 2019 was probably to some extent due to the Mobile Hospital LiiSa service, which is currently being operated in Espoo and Kauniainen. In all the assessed cities, other similar services for emergency care situations that can be provided at home to patients receiving long-term care or at-home care have also been developed: In Vantaa, the LiiSa service has been initiated jointly with HUS; in 2021, Helsinki initiated a mobile nurse service (Liiho).

HUS and the cities have developed guidelines, operating methods and services related to elderly patients’ emergency care situations via the GeroMetro elderly persons’ service development network. These include, in addition to the mobile services, for example, emergency care manuals for at-home care and service housing care. A HUS geriatrics project has been developing elderly patients’ specialist medical care and the integration of treatments jointly with primary care providers. With regard to the follow-up care and discharging of elderly patients, division of work between the cities and HUS and the relevant operating model have been developed, but all municipalities do not collaborate with HUS as closely as others and operating models also vary.

Audit committees’ recommended follow-up measures

The audit committees recommend that further monitoring should be implemented to assess the impacts of the developed measures on elderly patients’ emergency care visit numbers and at-home safety. The audit committees also want to emphasise the need for further collaboration between HUS and cities in the Helsinki Metropolitan Area to develop such operating methods and services for elderly patients’ emergency care situations that can improve the functional capabilities and well-being of elderly patients. Additionally, the audit committees recommend that the cities and HUS develop their collaboration further especially with regard to the discharging process to address the growing need for services.
Since 2008, the audit functions of the cities in the Helsinki Metropolitan Area have implemented a total of 11 joint assessments. The HUS audit unit began participating in these joint audits in 2018.

The cities and HUS gave recommendations on this subject in their assessment reports in 2021.