SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services)
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Share PrintSCOUTS is a post emergency department (ED) complementary service utilizing Intermediate Care Technicians (ICTs) to support care transitions by ensuring unmet care needs, geriatric syndromes, 4Ms of Age-Friendly Health System, and digital divide concerns are addressed in an acute time frame. ICTs serve a Telepresenters in the Veterans home as a provider performs a telehealth visit.
Origin:
December 2020, Office of Primary Care
Adoptions:
11 successful, 6 in-progress
Awards and Recognition:
Office of Rural Health Enterprise Wide Initiative, Society of Academic Emergency Medicine 2022 Best Faculty Geriatric Abstract, Diffusion of Excellence Promising Practice, VHA Shar ... Office of Rural Health Enterprise Wide Initiative, Society of Academic Emergency Medicine 2022 Best Faculty Geriatric Abstract, Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Emergency Medicine, Geriatrics and Extended Care, Office of Connected Care, Office of Primary Care, Office of Rural Health
Recent Updates
Overview
The problem
More than 1 million Veterans 65 years and older visit US Department of Veterans Affairs (VA) Emergency Departments (ED) each year and billions of dollars are spent each year on community emergency care for Veterans. In general, compared to younger patients, older adults experience higher ED admission rates and more frequent ED revisits. Older adult ED visi
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More than 1 million Veterans 65 years and older visit US Department of Veterans Affairs (VA) Emergency Departments (ED) each year and billions of dollars are spent each year on community emergency care for Veterans. In general, compared to younger patients, older adults experience higher ED admission rates and more frequent ED revisits. Older adult ED visits are often driven by unmet needs or unrecognized geriatric syndromes. The 4M Model of Age Friendly Health Systems (mentation, medication, mobility and what matters) is a healthcare model that aims to provide patient centered, inclusive and comprehensive care for older adults. VAs have sought innovative responses to address: 1) emergency department 4M delivery, 2) transitions of care, and 3) social determinates of health, including the digital divide experienced by older adults. This approach resulted in the VA launching a feasibility pilot program, SCOUTS (Supporting Community, Outpatient, Urgent Care & Telehealth Services), at six of VA EDs in 2021. Additional motivations for addressing the digital divide were the VA goals of increasing access to care through telehealth and decreasing the number of patients requiring healthcare facility visits during the COVID pandemic.
See
more
Links
- VA Age Friendly Health Systems Initiative VA Age Friendly Health Systems Initiative
- VA News article VA Emergency Departments Ready for Older Veterans
The solution
SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services) is a post Emergency Department (ED) care transition program for older community dwelling Veterans. These Veterans are identified during their ED visit as high risk for functional decline, hospitalization, institutionalization, falls, or repeat ED visit. In SCOUTS, Intermediate Care T
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SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services) is a post Emergency Department (ED) care transition program for older community dwelling Veterans. These Veterans are identified during their ED visit as high risk for functional decline, hospitalization, institutionalization, falls, or repeat ED visit. In SCOUTS, Intermediate Care Technicians (ICTs) perform a rapid follow up home visit, typically in 48-72 hours, that serves multiple purposes. This follow up home visit allows the patient’s acute condition to be reassessed, in-home screenings for undiagnosed geriatric screens and screens for unmet care needs to be completed, care coordination to be facilitated, and telehealth connections to VA ED providers to be accomplished.
The SCOUTS home visit allows ED providers to discharge patients from the ED with confidence, knowing their upcoming SCOUTS home visit will provide acute follow up in the home with the ICT acting as a telepresenter, which is typically not available unless a patient is already enrolled in a home-based primary care program. Additionally, this program serves Veterans who may not meet eligibility for Patient Aligned Care Team (PACT) home based primary care as they require episodic rather than longitudinal care, but still benefit from home safety evaluations and in home observations for acute conditions. This program has been especially beneficial to frail rural Veterans whom lengthy travel to a VA medical center can lead to further functional decline. It allows the Veteran to experience the convenience of telehealth care with an acute care provider, without missing out on the benefits of an in person visit through telehealth technology such as virtual wound cameras and tablet connected devices such as otoscopes and stethoscopes. The in-person home visit also allows for minor procedures to be performed such as suture removal. See more
The SCOUTS home visit allows ED providers to discharge patients from the ED with confidence, knowing their upcoming SCOUTS home visit will provide acute follow up in the home with the ICT acting as a telepresenter, which is typically not available unless a patient is already enrolled in a home-based primary care program. Additionally, this program serves Veterans who may not meet eligibility for Patient Aligned Care Team (PACT) home based primary care as they require episodic rather than longitudinal care, but still benefit from home safety evaluations and in home observations for acute conditions. This program has been especially beneficial to frail rural Veterans whom lengthy travel to a VA medical center can lead to further functional decline. It allows the Veteran to experience the convenience of telehealth care with an acute care provider, without missing out on the benefits of an in person visit through telehealth technology such as virtual wound cameras and tablet connected devices such as otoscopes and stethoscopes. The in-person home visit also allows for minor procedures to be performed such as suture removal. See more
Files
- SCOUTS presentation at American Geriatrics Society Annual Meeting American Geriatric Society SCOUTS Presentation
Links
- Palo Alto SCOUTS SCOUTS Pilot streamlines care for older Veterans
- Local news feature story VA Western Colorado Implements SCOUTS Program
- Local news feature story VA Adds New Program to Help Veterans
- Local news feature story U.S. Secretary of Veterans Affairs' visit highlights VA's new program for high-risk vets
The results
A planned analysis of outcomes from May 2021-May 2022 was conducted. Propensity score matching was used to compare ED hospitalization and revisit rates and outpatient service referrals of SCOUTS patients (N=684) and a matched group (N=684). Propensity parameters were frailty score, age, gender, prior 30 day hospitalization, prior 30 day ED visit, and facili
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A planned analysis of outcomes from May 2021-May 2022 was conducted. Propensity score matching was used to compare ED hospitalization and revisit rates and outpatient service referrals of SCOUTS patients (N=684) and a matched group (N=684). Propensity parameters were frailty score, age, gender, prior 30 day hospitalization, prior 30 day ED visit, and facility.
SCOUTS ED patients had higher frailty scores and were more likely to have prior 30 day hospitalization and prior ED visit compared to a cohort including all ED patients age 65+. Propensity matched SCOUTS patients were more likely to be discharged home from the ED (admit rate 3.5% vs 21.2% p<0.001) and less likely to be admitted to the hospital in the next 30 or 90 days (11.7 vs 26.9% and 20 vs 32.5% respectfully) When also matched for admission status, discharged SCOUTS patients had lower rates of 72-hour ED return visits (1.5% vs 5.2%p<0.001) and were more likely to receive durable medical equipment (50.7% vs 34.7%, p<0.001) and a referral to outpatient social work to access VA and community services (15.6 % vs 10.8 %, p<0.01). See more
SCOUTS ED patients had higher frailty scores and were more likely to have prior 30 day hospitalization and prior ED visit compared to a cohort including all ED patients age 65+. Propensity matched SCOUTS patients were more likely to be discharged home from the ED (admit rate 3.5% vs 21.2% p<0.001) and less likely to be admitted to the hospital in the next 30 or 90 days (11.7 vs 26.9% and 20 vs 32.5% respectfully) When also matched for admission status, discharged SCOUTS patients had lower rates of 72-hour ED return visits (1.5% vs 5.2%p<0.001) and were more likely to receive durable medical equipment (50.7% vs 34.7%, p<0.001) and a referral to outpatient social work to access VA and community services (15.6 % vs 10.8 %, p<0.01). See more
Links
- Feasibility study outcomes Telehealth for geriatric post-emergency department visits to promote age-friendly care
- VA Insider Story Trust in the field, trust at home
Metrics
- Number of Veterans served
- Emergency department revisit rates
- Hospital admission rate
- Number and type of Veteran connections to VA services
- Community emergency department usage
- Veteran and caregiver satisfaction
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1 month
Identify physician medical director and Intermediate Care Technicians who will participate in the program (if you need to create new positions expect this step to take 6-9 months) -
1-3 months
Develop workflow for identifying and tracking eligible SCOUTS patients and coordinating with acute care providers for telehealth portion (this may involve changing ED, telehealth or follow up practices, creating new clinic codes or consults) -
1-3 months
ICTs complete SCOUTS block training modules: geriatric emergency medicine, homecare, and telehealth plus competency sign off (timeline may be shorter if ICTs have already completed training and competency sign off on geriatric ED screens and minor procedures or have attended the SimLearn Foundational ICT training for emergency medicine) -
1 month
Work with Clinical Application specialists to upload SCOUTS electronic template notes and test for local usability -
1-3 months
Socialize program with services who will receive consults or follow up requests as a result of SCOUTS screenings (eg prosthetics, physical therapy, primary care team members (social work, nurse case managers, primary care, pharmacists), geriatrics) -
1 month
Obtain tablets and other telehealth support equipment (eg digital stethoscopes, scale, wound camera, digital otoscope) -
1-2 month
Work with prosthetics or local supply to obtain standing stock clinic items to dispense to Veterans during home visits (eg hearing amplifiers, canes, walkers, pill organizers) -
1 week
Review SCOUTS administrative documents and internal SCOUTS project website
Departments
- Emergency care
- Education and training
- Primary care
Core Resources
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Links
- VHA Intermediate Care Technician (ICT) Program Diffusion Marketplace: ICT Home Page
- VA ED Geriatric Emergency Department Program Diffusion Marketplace: Geriatric Emergency Department Program
- Journal of Geriatric Emergency Medicine (JGEM) ICT Workforce for Veterans Affairs Geriatric Emergency Departments
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