The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study

Glenn Arendts,Mark Donaldson,Sarah Fitzhardinge,Karren Pronk,Yusuf Nagree,Marani Hutton

doi:10.1186/1471-2318-12-8

Abstract

BackgroundThis study sought to determine whether early allied health intervention by a dedicated Emergency Department (ED) based team, occurring before or in parallel with medical assessment, reduces hospital admission rates amongst older patients presenting with one of ten index problems.MethodsA prospective non-randomized trial in patients aged sixty five and over, conducted in two Australian hospital EDs. Intervention group patients, receiving early comprehensive allied health input, were compared to patients that received no allied health assessment. Propensity score matching was used to compare the two groups due to the non-randomized nature of the study. The primary outcome was admission to an inpatient hospital bed from the ED.ResultsOf five thousand two hundred and sixty five patients in the trial, 3165 were in the intervention group. The admission rate in the intervention group was 72.0% compared to 74.4% in the control group. Using propensity score probabilities of being assigned to either group in a conditional logistic regression model, this difference was of borderline statistical significance (p = 0.046, OR 0.88 (0.76-1.00)). On subgroup analysis the admission rate in patients with musculoskeletal symptoms and angina pectoris was less for those who received allied health intervention versus those who did not. This difference was significant.ConclusionsEarly allied health intervention in the ED has a significant but modest impact on admission rates in older patients. The effect appears to be limited to a small number of common presenting problems.

Highlights

This study sought to determine whether early allied health intervention by a dedicated Emergency Department (ED) based team, occurring before or in parallel with medical assessment, reduces hospital admission rates amongst older patients presenting with one of ten index problems
The objective of this study was to assess whether early multidisciplinary allied health targeting of specific diagnoses, undertaken before ED medical assessment had been completed or even commenced, would change admission rates in older patients presenting to the ED with these problems
Of these 1153 were resuscitation or critical cases; 17956 had presenting complaints that could not be related to the index diagnoses or had their entire ED stay occur outside of care coordination team (CCT) working hours; leaving 5265 patients (3165 intervention and 2100 control) meeting inclusion criteria

Summary

Introduction

This study sought to determine whether early allied health intervention by a dedicated Emergency Department (ED) based team, occurring before or in parallel with medical assessment, reduces hospital admission rates amongst older patients presenting with one of ten index problems. Presentations to the emergency department (ED) are increasing at a rate that exceeds population growth [1] This increase is across all age ranges but highest in older people (defined here as aged 65 and over) [2]. The objective of this study was to assess whether early multidisciplinary allied health targeting of specific diagnoses, undertaken before ED medical assessment had been completed or even commenced, would change admission rates in older patients presenting to the ED with these problems. We hypothesised that the front loading of specialised geriatric allied health services provided by a care coordination team (CCT) would increase the likelihood of ED discharge (and so reduce admission rates) in people with these selected conditions

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