Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults: A randomised controlled trial
| Autor: | Andrew O’Regan, Eimear Smalle, Fiona Steed, Rose Galvin, Marica Cassarino, Dominic Trépel, Damien Ryan, Fiona Boland, Collette Devlin, Rosie Quinn, Rosa McNamara, Stephen White, Margaret O'Connor, Gerard McCarthy, Katie Robinson, Íde O’Shaughnessy, Marie Ward |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Critical Care and Emergency Medicine Health Services for the Aged law.invention 0302 clinical medicine Patient Admission Elderly Randomized controlled trial Quality of life law Medicine and Health Sciences Medicine 030212 general & internal medicine Aged 80 and over 030503 health policy & services General Medicine Hospitals Treatment Outcome Patient Satisfaction Marital status Female 0305 other medical science Emergency Service Hospital Research Article medicine.medical_specialty Drug Research and Development Referral Patients Health Personnel Research and Analysis Methods 03 medical and health sciences Patient satisfaction Intervention (counseling) Early Medical Intervention Humans Adults Clinical Trials Aged Patient Care Team Pharmacology business.industry Social Support Emergency department Length of Stay Triage Randomized Controlled Trials Nursing Homes Health Care Health Care Facilities Age Groups Emergency medicine People and Places Quality of Life Population Groupings Clinical Medicine business |
| Zdroj: | PLoS Medicine PLoS Medicine, Vol 18, Iss 7, p e1003711 (2021) |
| ISSN: | 1549-1676 |
| Popis: | Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED. Methods and findings This single-site randomised controlled trial included a sample of 353 patients aged ≥65 years (mean age = 79.6, SD = 7.01; 59.2% female) who presented with lower urgency complaints to the ED a university hospital in the Mid-West region of Ireland, during HSCP operational hours. The intervention consisted of early assessment and intervention carried out by a HSCP team comprising a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included rates of hospital admissions from the ED; hospital length of stay for admitted patients; patient satisfaction with index visit; ED revisits, mortality, nursing home admission, and unscheduled hospital admission at 30-day and 6-month follow-up; and patient functional status and quality of life (at index visit and follow-up). Demographic information included the patient’s gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalisation history. Participants in the intervention group (n = 176) experienced a significantly shorter ED stay than the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED (19.3% versus 55.9%, p < 0.001), higher levels of satisfaction with the ED visit (p = 0.008), better function at 30-day (p = 0.01) and 6-month follow-up (p = 0.03), better mobility (p = 0.02 at 30 days), and better self-care (p = 0.03 at 30 days; p = 0.009 at 6 months). No differences at follow-up were observed in terms of ED re-presentation or hospital admission. Study limitations include the inability to blind patients or ED staff to allocation due to the nature of the intervention, and a focus on early assessment and intervention in the ED rather than care integration following discharge. Conclusions Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and the risk of hospital admissions among older adults, as well as improving patient satisfaction. Our findings support the effectiveness of an interdisciplinary model of care for key ED outcomes. Trial registration ClinicalTrials.gov NCT03739515; registered on 12 November 2018. Marica Cassarino and colleagues evaluate an intervention for early assessment of older patients in emergency care. Author summary Why was the study done? Some studies suggest that older patients presenting to the emergency department (ED) could benefit from receiving early assessment and intervention by a dedicated health and social care professional (HSCP) team, particularly in terms of safer discharges and increased patient and staff satisfaction. To date, no methodologically robust studies exist that have tested the effectiveness of this interdisciplinary model of ED care for older adults. In this randomised controlled trial, we evaluated the impact of an ED-based HSCP team dedicated to older patients on ED length of stay, incidence of hospital admissions, and other measures of quality and safety of care. What did the researchers do and find? Compared to those receiving usual ED care, patients who were treated by the HSCP team spent less time in the ED, had lower rates of hospital admission, and were satisfied with their care, as well as reporting better function at follow-up. We observed no differences in the numbers of patients re-presenting to the ED at 30 days or 6 months. What do these findings mean? Having a dedicated HSCP team that provide early assessment and intervention to older people with lower urgency conditions can improve quality and timeliness of ED care. Further research is needed to understand whether these benefits can extend to other patient populations, as well as clarifying implications for integration of care post-discharge from the ED. |
| Databáze: | OpenAIRE |
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