Abstract
BackgroundOlder people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously.MethodsIn this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions.ResultsThere were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively.ConclusionsVideo-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support.Trial registrationThe larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.
Highlights
Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration
Study design This exploratory study was a controlled pre-post study conducted after the completion of a larger stepped wedge non-randomized trial, which assessed the effect of the Aged Care Emergency (ACE) program [13]
There was a total of 733 hospital admissions across the 28-month period of the study for the 13 RACs; 226 from RACs that received intervention (115 in the pre-telehealth phase and 111 in the post-telehealth phase) and 507 from RACs that did not receive the telehealth strategy (249 in the pre-telehealth phase and 258 in the post-telehealth phase)
Summary
Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. It has the potential to provide frail, older adults, those living in Residential Aged Care (RAC), with timely, patient-centered care where transfer to hospital can itself be a burden [2] and potentially avoided. RAC residents have higher risks of hospitalization, and Emergency Department (ED) visits [6,7,8,9,10] than older people who are living in the community [11]. Older people in RACs are living the last years of their life They are at high risk of acute clinical deterioration, often complicated by frailty and multi-morbidity [5]. It is important to recognise that when avoiding hospitalization, residents of RACs should still receive the acute care they require, in line with their goals of care
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