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To share our experience of establishing an acute outreach service to nursing homes and to evaluate the impact of such service on emergency department presentations, data were drawn from a pre‐existing database from 2013 to 2017. Of the 986 acute patients treated in 12 nursing homes over a 23‐month period, the acute geriatric outreach service was shown to be safe, with few adverse events (one allergic reaction) and 5.3% of patients required transfer to hospital. The acute service decreased emergency department presentation of nursing home patients by 10% compared to the subacute service (incidence rate ratio = 0.90; 95% confidence interval: 0.84–0.96; P = 0.001). Cost–benefit analysis showed for every $1 spent, a saving of $5 was realised.

A 102-year-old woman was previously well, independent in her daily activities and lived with her son. She presented to our hospital with a 3-day history of non-specific abdominal and bilateral upper leg pain, absolute constipation and one episode of dark vomitus. On examination, she was 55 kg, slightly dehydrated, afebrile, blood pressure 130/85 mmHg, pulse rate 80/min, respiratory rate 18/min and S A O 2 99% with room air. Her abdomen was mildly distended and tender on deep palpation centrally. There was no other significant finding on examination. She was reviewed by a geriatrician the next morning and was found to have both hips in flexion position with no visible femoral or inguinal hernia.Plain abdominal radiograph showed dilated loops of small bowel with multiple fluid levels on decubitus views. Chest radiograph showed no gas under the diaphragm. Her urea was slightly raised at 15 mm/L, white cell count was mildly increased at 12.2 Â 10 6 /L, whereas electrolytes, amylase, lipase, haemoglobin and platelets were normal.Obturator hernia was suspected and was confirmed by abdominal computed tomography (CT) scan, which showed a solitary bowel loop in the left obturator canal posterior to the pectineus muscle. Emergency laparotomy was carried out, which showed complete distal small bowel obstruction secondary to the hernia. A 10-cm segment of infracted small bowel was resected. The hernia was reduced and small bowel anastomosis was carried out; peritoneum over the obturator space was opened with polypropylene mesh repair.

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