Abstract
BackgroundOlder people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia.MethodsA stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers.DiscussionThe intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives.Trial registrationThe trial is prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
Highlights
Older people living in residential aged care homes experience frequent emergency transfers to hospital
Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration
The Early Detection of Deterioration in Elderly residents (EDDIE)+ program is focussed on upskilling nursing staff and personal care workers within residential aged care (RAC) homes so they can better recognise and manage early signs of deterioration in residents, with the aim of reducing unnecessary hospital admissions
Summary
Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. A recent report from the Australian Medical Association estimated that there were over 27,000 potentially preventable hospital admissions from RAC homes in 2020–21, which translated to approximately 160,000 patient bed days and $AU 312 million in hospital costs [7]. There were an estimated 49,000 of these non-admitted ED presentations from RAC homes in 2020–21, accounting for $AU 112 million in transport and ED triage costs [7]
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