Abstract
BackgroundOlder people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased ED length of stay, and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and an improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCP teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, and clinical- and cost-effectiveness of care of older adults when compared with usual care.MethodsThe study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30 days, and 4 and 6 months of follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; cost-effectiveness in terms of costs associated with ED-based HSCP compared with usual care; and perceptions on implementation by ED staff members.DiscussionThis is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients. The findings of this study will provide important information on the effectiveness of this model of care for future implementation.Trial registrationClinicalTrials.gov, NCT03739515. Registered on 12 November 2018.
Highlights
Older people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased emergency departments (EDs) length of stay, and tend to have raised healthcare costs
Cassarino et al Trials (2019) 20:591 (Continued from previous page). This is the first randomised controlled trial testing the impact of health and social care professional (HSCP) working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients
Evidence from international studies demonstrates that health and social care professionals (HSCPs) such as physiotherapists, occupational therapists and medical social workers can play a role in the ED in reducing length of patient stay, avoiding unnecessary hospital admissions and improving the patient experience [6,7,8,9]
Summary
Evidence from international studies demonstrates that health and social care professionals (HSCPs) such as physiotherapists, occupational therapists and medical social workers can play a role in the ED in reducing length of patient stay, avoiding unnecessary hospital admissions and improving the patient experience [6,7,8,9]. A recent systematic review [6] demonstrated that care coordination teams comprising of HSCPs (including physiotherapists, occupational therapists and medical social workers) that provide early assessment and intervention to older adults in the ED can contribute to safer discharges and increased patient and staff satisfaction; the quality of the evidence is mixed, primarily due to inherent weaknesses in study designs and heterogeneity of patient groups and outcomes of interest
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