Despite geographical differences, emergency departments around the world share many of the
Colin Fleming, Rusette Tesani and Christopher John Fernandez presented case studies about models of community-based care in three countries: the United States, England and the Philippines.
same pressures and challenges, including staff shortages, workforce burnout, financial strains and a growing aging population. Yet when it comes to seeking solutions, ED staff and leaders often don’t think beyond their own country’s borders.
Three members of ENA’s Global Advisory Committee challenged Emergency Nursing 2026 attendees to think globally about ED challenges during their session, “Global Emergency Care, Beyond Hospital Walls: Extending Care into the Community to Reduce ED Attendance and Boarding.”
“We all approach it in a different way. So, because we’re approaching it in a different way, we may come up with a different solution that maybe you haven’t considered,” said session co-presenter Colin Fleming, MSc, RN, CEDE, clinical director of emergency services and nursing clinical operations at Cleveland Clinic Abu Dhabi in the United Arab Emirates.
The panelists presented case studies about models of community-based care in three countries — the United States, England and the Philippines — and encouraged attendees to consider how they might adapt such programs to fit their own community’s needs and circumstances.
In rural Oregon, community paramedics and other prehospital clinicians provide at-home wellness checks to frequent ED users and patients with chronic conditions, post discharge needs or access barriers. They assess vital signs, medication adherence and whether patients have followed up with a primary care provider, then escalate care if needed. The program has reduced avoidable ED visits among Medicaid users by 38.9 percent and 30-day readmissions by 60 percent.
“There is also an economical impact to this,” said session co-presenter Rusette Tesani, BSN, RN, director of nursing at Jacobson Memorial Hospital Care Center in Elgin, North Dakota.
In England, multidisciplinary acute care teams provide at-home care to patients who need acute hospital-level care but can be safely managed at home. In patients with frailty, the program helps reduce deconditioning and loss of independence in patients that often accompanies hospital admission.
A program in the Philippines takes yet another innovative approach, tapping trained community responders and locally available health workers, often on a volunteer basis, to check on patients at home. They’ll take vital signs, ask how they’re doing and even complete paper charting. Then they check in with the local health center to determine whether they need additional care.
The session also covered five steps EDs can take to implement similar models in their own
facilities, including defining the need; selecting the approach; assessing the local context; building the pathway for referral, communication, escalation and follow-up; and testing whether the model works and adapting as needed.
Session co-presenter Christopher John Fernandez, BSN, RN, CEN, an ED nurse at Scarborough Health Network in Toronto, encouraged attendees to think about their own populations within the context of those models.
“It is just time to really reflect on those cases where we can maybe do something different,” he said.
The session inspired attendee Dorian Hogsten, AS, RN, a nurse at UF Health Shands trauma center in Gainesville, Florida, to consider similar solutions for his own facility.
“I’d like to open up some communications channels with our social work and with some of our EMS personnel that I have close relationships with to talk about how we could start to implement some of this,” he said.