Impact of an Allied Health Team in the Emergency Department on Older Adults' Care

NCT03739515 | Unknown DMC

• 1 other identifier: Optimend_WP4
• Study Type: interventional
• Target: 354
• Locations: 1 country
• Sites: 1

Brief Summary

The study aims to examine the impact of implementing a dedicated team of Health and Social Care Professionals (HSCPs) in the emergency department (ED) of a large Irish hospital on the quality, safety and cost-effectiveness of care for older adults (aged ≥65). Early assessment and intervention provided by the HSCP team will be compared to routine ED care to explore potential benefits related to key ED outcomes, including length of stay as well as hospital admissions and patient satisfaction/quality of life. This study is part of an ongoing interdisciplinary project funded by the Health Research Board of Ireland through the Research Collaborative on Quality and Patient Safety (RCQPS) Grant Call 2017. The project is led by Dr Rose Galvin, Senior Lecturer in Physiotherapy at the University of Limerick (UL, Ireland), and overseen by an interdisciplinary steering group of expert researchers and clinicians in Emergency Medicine and Allied Health.

Conditions

ED-based Allied Health Services

Keywords

Emergency department; Health and Social Care Professional; Team care; Older patients; Effectiveness

Outcome Measures

Primary Outcomes (1)

• ED length of stay

  Hours from ED admission to discharge

  1-24 hours (one day) after accessing the ED

Secondary Outcomes (10)

• Incidence of Representations

  30 days, four months, and six months after index visit

• Incidence of Healthcare utilization

  30 days, four months, and six months after index visit

• Functional status

  Baseline, 30 days and six months after index visit

• Patient quality of life

  Baseline, 30 days, four months and six months after index visit

• Patient satisfaction with index visit

  At time of index visit

Study Arms (2)

HSCP team

EXPERIMENTAL

Patients in this arm will receive comprehensive assessment and/or pre-discharge services by an ED-based HSCP team

Other: HSCP intervention

Routine care

ACTIVE COMPARATOR

Patients in this arm will receive routine ED care

Other: ED routine care

Interventions

HSCP intervention OTHER

A team of HSCPs (physiotherapist, occupational therapist, medical social worker) will provide comprehensive functional assessment to older patients

HSCP team

ED routine care OTHER

ED staff including consultants and nurses will provide patients with routine ED medical care.

Routine care

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• ≥65 years
• Medically stable (treating physician)
• Off baseline mobility
• Capacity (Mini Mental State Examination score ≥17) and willingness to provide informed consent
• Presenting during HSCP operational hours (8am-5pm Monday-Friday)

You may not qualify if:

• Under 65 years
• Medically unstable
• Neither the patient nor the carer can communicate in English sufficiently to complete consent or baseline assessment
• Present outside HSCP operational hours.

Sponsors & Collaborators

• University of Limerick: lead
• University Hospital of Limerick: collaborator

Study Sites (1)

University Hospital Limerick

Limerick, Co. Limerick, F858, Ireland

Location

Related Publications (9)

• Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh. 2014 Mar;46(2):106-15. doi: 10.1111/jnu.12055. Epub 2013 Dec 19.

  PMID: 24354886 BACKGROUND

• Arendts G, Fitzhardinge S, Pronk K, Hutton M. Outcomes in older patients requiring comprehensive allied health care prior to discharge from the emergency department. Emerg Med Australas. 2013 Apr;25(2):127-31. doi: 10.1111/1742-6723.12049. Epub 2013 Feb 19.

  PMID: 23560962 BACKGROUND

• Cassarino M, Robinson K, Quinn R, Naddy B, O'Regan A, Ryan D, Boland F, Ward ME, McNamara R, McCarthy G, Galvin R. Effectiveness of early assessment and intervention by interdisciplinary teams including health and social care professionals in the emergency department: protocol for a systematic review. BMJ Open. 2018 Jul 16;8(7):e023464. doi: 10.1136/bmjopen-2018-023464.

  PMID: 30012796 BACKGROUND

• Trepel D, Ruiz-Adame M, Cassarino M, Ahern E, Devlin C, Robinson K, O'Shaughnessy I, McCarthy G, Corcoran C, Galvin R. The cost effectiveness of early assessment and intervention by a dedicated health and social care professional team for older adults in the emergency department compared to treatment-as-usual: Economic evaluation of the OPTI-MEND trial. PLoS One. 2024 Jun 25;19(6):e0298162. doi: 10.1371/journal.pone.0298162. eCollection 2024.

  PMID: 38917081 DERIVED

• Cassarino M, Cronin U, Robinson K, Quinn R, Boland F, Ward ME, McNamara R, O'Connor M, McCarthy G, Ryan D, Galvin R. Development and delivery of an allied health team intervention for older adults in the emergency department: A process evaluation. PLoS One. 2022 May 26;17(5):e0269117. doi: 10.1371/journal.pone.0269117. eCollection 2022.

  PMID: 35617330 DERIVED

• Cassarino M, Robinson K, Trepel D, O'Shaughnessy I, Smalle E, White S, Devlin C, Quinn R, Boland F, Ward ME, McNamara R, Steed F, O'Connor M, O'Regan A, McCarthy G, Ryan D, Galvin R. 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. PLoS Med. 2021 Jul 28;18(7):e1003711. doi: 10.1371/journal.pmed.1003711. eCollection 2021 Jul.

  PMID: 34319971 DERIVED

• Griffin A, O'Neill A, O'Connor M, Ryan D, Tierney A, Galvin R. The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr. 2020 Nov 7;20(1):455. doi: 10.1186/s12877-020-01852-w.

  PMID: 33160319 DERIVED

• Cassarino M, Robinson K, O'Shaughnessy I, Smalle E, White S, Devlin C, Quinn R, Trepel D, Boland F, Ward ME, McNamara R, O'Connor M, McCarthy G, Ryan D, Galvin R. A randomised controlled trial exploring the impact of a dedicated health and social care professionals team in the emergency department on the quality, safety, clinical and cost-effectiveness of care for older adults: a study protocol. Trials. 2019 Oct 15;20(1):591. doi: 10.1186/s13063-019-3697-5.

  PMID: 31615573 DERIVED

• Cassarino M, Cronin U, Robinson K, Quinn R, Boland F, Ward ME, MacNamara R, O'Connor M, McCarthy G, Ryan D, Galvin R. Implementing an allied health team intervention to improve the care of older adults in the emergency department: protocol for a process evaluation. BMJ Open. 2019 Jul 16;9(7):e032645. doi: 10.1136/bmjopen-2019-032645.

  PMID: 31315881 DERIVED

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Rose Galvin, PhD

  University of Limerick

  PRINCIPAL INVESTIGATOR

• Damien Ryan, PhD

  University Hospital of Limerick

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: To minimise the possibility of selection bias, a person independent of the recruitment process will complete random group allocation. Computer generated random numbers will be created and placed in sealed envelopes by this independent person. These numbers will be stored in the pre-sealed envelopes in a locked drawer in the Health Research Institute at the Clinical Education and Research Centre (CERC). Allocation will be revealed after recruitment by a telephone call from the dedicated research nurse to this independent person, who will open the next envelope in the sequence and give the randomisation information to the research nurse. Each envelope will be opened on enrolment of an eligible participant. After allocation is revealed, the appropriate intervention will be organised by the team. In addition, the outcome assessment will be conducted by a research nurse blinded to the patient allocation in order to reduce potential detection bias.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Eligible participants will be randomly assigned to either the experimental group (ED-based HSCP intervention) or the control group (ED routine care). By assigning participants at random, it is possible to infer that any observed group differences are attributable to the independent variable (the intervention under investigation).

Study Record Dates

• First Submitted: November 7, 2018
• First Posted: November 13, 2018
• Study Start: December 3, 2018
• Primary Completion: November 30, 2019
• Study Completion: November 30, 2019
• Last Updated: September 6, 2019

Record last verified: 2019-09

Data Sharing

• IPD Sharing: Will not share

Locations

IE (1)