CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

Abstract

BackgroundOlder inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention.MethodsA hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards.DiscussionUsing a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation.Trial registration ACTRN12615000879561 registered prospectively 21/8/2015.

Hospital‐Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care

“…We used data from the preintervention cohort of the Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital (CHERISH) trial, a multisite cluster‐randomized controlled trial of the Eat Walk Engage intervention, which is designed to reduce hospital‐associated complications in older inpatients. The trial's methods have been published previously . In brief, during this observational phase, we enrolled consecutive consenting inpatients aged 65 and older with lengths of stay 3 days or more on 8 medical or surgical wards in 4 hospitals from October 2015 to April 2016.…”

“…The trial's methods have been published previously. 23 In brief, during this observational phase, we enrolled consecutive consenting inpatients aged 65 and older with lengths of stay 3 days or more on 8 medical or surgical wards in 4 hospitals from October 2015 to April 2016. Individuals were excluded if they were unable to be reviewed within 72 hours, were discharged within 72 hours, or were terminally ill.…”

Use of hand grip strength in nutrition risk screening of older patients admitted to general surgical wards

“…The present study was a sub-study of the Collaborative for Hospitalised Elders, Reducing the Impact of Stays in Hospital (CHERISH) study. 24 Consecutive eligible patients ≥65 years were prospectively recruited (September 2015 to March 2016) from two general surgical wards at a large tertiary teaching hospital in Brisbane, Australia. Eligibility criteria included a length of stay ≥72 hours, not critically ill or palliated, and informed consent could be obtained.…”

Lama Rawat Inap Pasien Geriatri dengan Bakteremia Gram Negatif: Sebuah Observasi Analitis

“…10 Pada studi sebelumnya, ditemukan bahwa pasien bakteremia dalam kelompok usia lanjut menunjukkan gejala dan tanda yang lebih sedikit atau tidak khas, namun berisiko lebih tinggi untuk mengalami kegagalan organ dan prognosis yang lebih buruk dibandingkan dengan kelompok usia yang lebih muda. [11][12][13][14] Dengan adanya perbedaan dalam penegakan diagnosis, tata laksana, dan prognosis antara kasus bakteremia pada kelompok usia lanjut dan usia yang lebih muda, diperkirakan kasus bakteremia pada kelompok usia lanjut membutuh waktu rawat yang lebih lama. Namun, pada standar tarif pelayanan program Jaminan Kesehatan Nasional (JKN), kasus bakteremia atau septikemia tidak dibedakan biayanya antara kelompok usia lanjut dengan kelompok usia lainnya.…”