A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Abstract

The aim of this randomised controlled trial involving 224 elderly patients was to determine whether early geriatric assessment (in the form of an aged care nurse intervention based in the emergency department) reduced admission to the hospital, length of inpatient stay (LOS), or functional decline during the hospitalisation. Baseline geriatric assessments were recorded in the medical files of intervention patients (n = 114). The nurse also liaised with the patients' carers and health care providers, organised referrals for out-of-hospital assessment and support services, and assisted in the care of those admitted as inpatients by documenting suggestions for assessment and referral. Assessment data from control patients (n = 110) were withheld, and the nurse had no further involvement in their inpatient or outpatient care. One hundred and seventy-one patients (76%) were admitted to the hospital, for a median LOS of 10 days. The nurse successfully identified those needing admission (odds ratio [OR], 14.0; 95% confidence interval [CI], 2.6-75.1). Thirty-nine of 160 inpatients with available data (24%) had a functional deterioration during the hospitalisation. The intervention had no significant effect on admission to the hospital (OR, 0.7; CI, 0.3-1.7), LOS (hazard ratio, 1.1; CI, 0.7-1.5) or functional decline during the hospitalisation ELDERLY PERSONS VISIT the emergency department (ED) more often than younger persons. 1 They often have serious complaints that limit function and restrict their ability to live independently. For many, hospitalisation results in functional decline despite cure or repair of the condition for which they were admitted. 2,3 Functional status is a strong predictor of LOS, mortality, and nursing home placement. 4,5 Early assessment of elderly patients can identify risk factors that contribute to hospital-acquired dependency. 2,6 The best models of care for older persons visiting emergency departments are not known, and few randomised, controlled trials of interventions in the ED setting have been published. A two-stage intervention, comprising screening and a brief standardised nursing assessment and referral, reduced the rate of functional decline four months after the ED visit. 7 The beneficial outcomes resulted primarily from early provi-

Local trends in emergency department attendances by older patients in an ageing national population

“…15 The implementation of these services was associated with a decrease in attendances by older mented in other parts of the country with varying success. [16][17][18][19][20][21][22] The quintessence of such services is an integrated, multidisciplinary approach to assist in the acute hospital and post-discharge care of older people at risk of repeated hospital presentations. The emphasis has been on returning these patients to and maintaining them in the community.…”

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

“…These interventions are resource-intensive and have had only intermittent success in decreasing hospitalizations, reducing ED visits, increasing primary care visits, and improving functional outcomes. [7][8][9][10][11][12][13][14] Several studies have found that comprehension of discharge instructions is a significant barrier to care compliance [15][16][17][18] and that many older patients discharged from the ED do not understand their discharge instructions, nor do they attend follow-up appointments. 18,19 Studies conducted in other patient populations have shown that telephone follow-up encourages compliance with discharge instructions and increases the likelihood of physician follow-up.…”

Efficiency and applicability of comprehensive geriatric assessment in the Emergency Department: a systematic review

“…Three studies showed no advantage in performing CGA with regard to outcome (functional decline, ED readmission, institutionalization, death) (37,38,40). The other five studies showed a reduction in functional decline after CGA in ED (10,11,36,39,41).…”

“…In the fi- nal phase, 4 studies regarding CGA efficiency were excluded because of lack of a control or matched group. Lastly, we included 8 studies on CGA (10,11,(36)(37)(38)(39)(40)(41)) and 14 on screening tools (9, 41-53) (1 study belongs to both selections).…”

“…One study was conducted in a tertiary hospital (37) and the others in university teaching hospitals. Except in the study by Mion et al (11), CGA was performed by nurses.…”