Abstract
Introduction: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Health and Social Care Professionals are well placed to develop and lead integrated care intervention for older adults discharged from the ED (ED PLUS) to prevent and reduce these well reported adverse outcomes.
Objective: Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED-PLUS).
Ethical Approval: Ethical approval was obtained from the HSE Mid-Western Area Research Ethics Committee (088/2020).
Method: Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. In addition, a multi-stakeholder qualitative evaluation was completed using a semi structured interview approach. Functional status, quality of life and unscheduled ED re-presentation rates were examined post-intervention. All outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.
Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback about the intervention. There was a trend towards improved function and quality of life, and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Nine older adults and six healthcare providers participated in the multi-stakeholder evaluation.
Conclusion: A pilot feasibility trial, ED PLUS, bridges the transition of care between the index visit to the ED and the community, for an older adult visiting the ED, is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID 19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Findings from this study will be used to refine the design and processes for a definitive RCT.