Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study

Abstract

Background Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously. Methods In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions. Results There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively. Conclusions Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support. Trial registration The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.

Does telehealth influence the decision to transfer residents of residential aged care facilities to emergency departments? A scoping review

“…The RACFs were located across a mix of urban and rural environments. The studies were led by different discipline groups, including pharmacists (Kane‐Gill et al, 2021 ), General Practitioners (GP) (Ohligs et al, 2020 ; Weiner et al, 2001 ), specialist physicians (Wakefield et al, 2004 ) geriatricians (Catic et al, 2017 ; Driessen et al, 2016 ; Pallawala & Lun, 2001 ), podiatrists (Corcoran et al, 2003 ), psychiatrists (Rabinowitz et al, 2010 ), social workers (Roques & Hovanec, 2002 ), dentists (Tynan et al, 2018 ), speech pathologists (Bidmead et al, 2015 ) and hospital departments and RACFs (Archbald‐Pannone et al, 2020 ; Chan et al, 2001 ; Chess et al, 2018 ; Grabowski & O'Malley, 2014 ; Gray et al, 2012 ; Harris et al, 2021 ; Hex et al, 2015 ; Hofmeyer et al, 2016 ; Hui et al, 2001 ; Hui & Woo, 2002 ; Hullick et al, 2022 ; Joseph et al, 2020 ; Laflamme et al, 2005 ; Low et al, 2020 ; Piau et al, 2018 ; Prandi et al, 2020 ; Salles et al, 2017 ; Stephens et al, 2019 ; Stern et al, 2014 ).…”

“…Study Design, two studies were cluster randomised stepped wedge trials (Kane‐Gill et al, 2021 ; Stern et al, 2014 ), and two were randomised controlled trials (Grabowski & O'Malley, 2014 ; Joseph et al, 2020 ) a pre/post‐study (Hullick et al, 2022 ). Four studies used mixed methods (Hui & Woo, 2002 ; Laflamme et al, 2005 ; Piau et al, 2018 ; Salles et al, 2017 ), and 39% of studies were descriptive ( n = 12) (Corcoran et al, 2003 ; Driessen et al, 2016 ; Gray et al, 2012 ; Harris et al, 2021 ; Low et al, 2020 ; Ohligs et al, 2020 ; Pallawala & Lun, 2001 ; Prandi et al, 2020 , Rabinowitz et al, 2010 ; Tynan et al, 2018 ; Wakefield et al, 2004 ; Weiner et al, 2001 ).…”

“…Outcomes/Findings, RACFs that were more engaged with telehealth had significant reductions in hospitalisations per year (Grabowski & O'Malley, 2014 ; Hofmeyer et al, 2016 ; Salles et al, 2014 ), less adverse events (Kane‐Gill et al, 2021 ), lower operating costs and increased staff satisfaction (Hui & Woo, 2002 ; Piau et al, 2018 ), found it acceptable (Corcoran et al, 2003 ; Wakefield et al, 2004 ), improved coordination of care and improved outcomes (Harris et al, 2020 ; Laflamme et al, 2005 ), high acceptance by GPs and nurses (Ohligs et al, 2020 ) and increased nurse confidence (Pallawala & Lun, 2001 ), acceptable for the residents (Prandi et al, 2020 ), significant cost‐savings and operating costs (Chan et al, 2001 ; Chess et al, 2018 ; Hex et al, 2015 ; Rabinowitz et al, 2010 ). However, some studies found that telehealth did not result in a significant reduction in ED visits (Hullick et al, 2022 ; Stern et al, 2014 ), was poorly utilised with no perceived confidence in its ability to influence hospital avoidance (Driessen et al, 2016 ), and that there were misunderstandings surrounding the telehealth and clinical abilities of the staff in the RACFs (Stephens et al, 2019 ).…”

“…Good 5-7 13 Bidmead et al, 2015;Chess et al, 2018;Corcoran et al, 2003;Driessen et al, 2016;Gray et al, 2012;Hullick et al, 2022;Kane-Gill et al, 2021;Laflamme et al, 2005;Low et al, 2020;Piau et al, 2018;Stephens et al, 2020;Stern et al, 2014;Wakefield et al, 2004. Fair 4-5 12 Chan et al, 2001Grabowski & O'Malley, 2014;Harris et al, 2021;Hex et al, 2015;Hofmeyer et al, 2016;Hui & Woo, 2002;Hui et al, 2001;Joseph et al, 2020;Ohligs et al, 2020;Rabinowitz et al, 2010;Salles et al, 2017;Tynan et al, 2018 Poor 0-4 6 Archbald-Pannone et al, 2020;Catic et al, 2017, Pallawala & Lun, 2001Prandi et al, 2020;Roques & Hovanec, 2002;Weiner et al, 2001 using significant text from the papers, using the framework as a guide.…”

Evaluation of clinical pharmacist-led medication review in patients referred to a hospital-based residential aged care support service

“…Models of care are continually evolving within Australian community and hospital settings. Hospital avoidance programs, such as the hospital-based Residential Aged-care Support Service (RaSS), use a model of care that provides support to people in RACFs who are unwell or deteriorating to the extent that their care needs exceed the capacity of RACF nursing staff and GPs [17][18][19][20][21][22][23][24][25]. In the Metro North Health service in Queensland, Australia, the RaSS aims to improve safety and quality of health care, minimise unnecessary and unplanned hospital presentations, and improve patient choice of care setting [26].…”