| Sumario: | Background Care home residents are a vulnerable population with high rates of emergency hospital use. Despite national guidance promoting multidisciplinary care, evidence for models involving geriatricians remains limited. The Enhanced Reviews in Care Homes service was developed to address this gap, providing proactive and reactive geriatrician input across the community/hospital interface. Methods We conducted a service evaluation using a controlled before-and-after design. The intervention was introduced sequentially across care homes between October 2024 and December 2025. Statistical process control (SPC) charts were generated monthly to monitor performance. Outcomes before and after implementation in intervention homes were compared with contemporaneous trends in all non-intervention care homes in the catchment area and analysed using longitudinal fixed effects regression. The primary outcome was monthly non-elective admissions. Secondary outcomes were monthly emergency department (ED) attendances and length of hospital stay. Results SPC charts demonstrated special-cause variation in the monthly non-elective admission rate and ED attendance rate. Statistical analyses of 6448 ED attendances (1611 from intervention homes; 4837 from controls), showed a significant reduction in emergency admissions, with a pooled post-implementation rate ratio of 0.77 (95% CI 0.60–0.97; P = .03). This effect emerged after several months consistent with progressive service penetration. Point estimates for secondary outcomes suggested reductions in ED attendances (rate ratio 0.79; 95% CI 0.61–1.02; P = .08) and length of stay (LOS) (ratio of means 0.68; 95% CI 0.50–0.92; P = .01). Conclusion Implementation of a geriatrician-led service was associated with a significant reduction in admissions and LOS, with point estimates also suggesting reductions in ED attendances.
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