Does a Targeted Engagement and Diversion program reduce emergency department utilization?

The Targeted Engagement and Diversion (TED) program in Ottawa provides health care to unhoused or shelter/community housed adults outside of an emergency department (ED) setting. We sought to determine the proportion of patients diverted away from the ED by the TED program.

We conducted a health records review of adult patients who visited the TED program from January to December 2022 using random sampling to account for seasonal variation. Data were extracted from the Ottawa Inner City Health database and hospital records from two university-affiliated EDs. The primary outcome was successful diversion from the ED, defined as any of the following: TED program patients (i) presenting in the evening or overnight; (ii) brought in by police/paramedic services; (iii) referred from the safe consumption site; (iv) assessed by a nurse or physician; (v) admitted for higher level of observation; or (vi) that received an antidote (e.g., naloxone). Data were described using descriptive statistics.

We reviewed 500 total visits of 241 unique patients (76.3% male, median age 38 years). The most common reason for presentation was unspecified intoxication (83.4%, n = 417). A total of 359 visits met criteria for successful diversion from the ED (71.8%, 95% confidence interval (CI) 67.7-75.6). Most patients who met diversion criteria revisited the TED program within 7 days (82.8%, n = 323), whereas 7.9% (n = 31) visited an ED within 7 days. At 2 years, 39% (n = 94) of all patients were stably housed and 10.8% (n = 26) died.

The TED program may be successful at attracting patients and diverting their care away from busy local EDs, and few patients treated by the TED program visited the ED within the subsequent 7 days. This model of care may provide a solution to offload from overcrowded EDs and improve access to comprehensive care for patients who are unhoused.