Hospitals test home-based treatment to avoid painful transport for elderly patients

Frail older adults in the Netherlands, many with dementia, who suffer suspected hip fractures are increasingly being treated at home or in care facilities under a new approach designed to avoid painful ambulance transport and hospital transfers. The model, currently used by a small group of anesthesiologists in parts of the country, will be examined in a national Amsterdam UMC study launching this year, NOS reports.

Nienke Hendriks, a geriatric care specialist at ZorgSpectrum, a healthcare organization operating in and around Nieuwegein, told NOS that the risk of hip fractures is relatively high among her patients, many of whom have dementia. She said the pain after a fall is severe, and ambulance transport adds further trauma when patients are moved from a stretcher to a hospital bed.

Since about a year ago, an anesthesiologist from nearby St. Antonius Ziekenhuis has been called to Hendriks’ patients. The doctor confirms the diagnosis on site and administers a long-acting nerve block, known as a PENG block, that can reportedly relieve pain.

The approach comes as the Netherlands faces a growing elderly population and rising pressure on healthcare staffing. The 2022 Integraal Zorg Akkoord set out to improve coordination across healthcare sectors to use limited personnel more efficiently. As part of this shift, fewer frail elderly patients with hip fractures are being sent to hospitals for automatic surgical treatment. In some cases, surgery is no longer considered the best option, particularly for very old patients with advanced dementia, when it does not improve or may even worsen quality of life.

Anesthesiologist Lennart Wasmoeth from St. Antonius Ziekenhuis, who frequently works with Hendriks, said the approach improves both patient experience and system efficiency.

“This approach is truly what you can call appropriate care,” Wasmoeth told NOS. "Because it is not only many times more pleasant for the patient, but in the bigger picture, the care becomes much more efficient."

He said ambulances are freed up for patients who genuinely require hospital transport, and hospital beds are also made available for other cases.

Despite growing interest from other hospitals, the model is still limited by staffing and organizational constraints. Amsterdam UMC is among the few institutions already offering it as standard care.

“Large hospitals such as academic medical centers often have an easier time deploying an anesthesiologist outside the hospital due to available personnel. For smaller regional hospitals with small anesthesia teams, that is more difficult,” said David Brinkman, an anesthesiologist at Amsterdam UMC. "That is one of the major obstacles we need to solve. For that, we also need to sit down with health insurers.”