Emergency Care at Home: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 229
- 试验地点
- 1
- 主要终点
- Participant with an emergency department presentation, observation, or hospitalization within 9 days
研究概览
简要总结
This study will assess the efficacy of receiving emergency care at home versus in the brick-and-mortar emergency department.
详细描述
Care in an emergency department has many benefits. It delivers high-intensity critical care on demand to large populations and serves as an efficient gateway to hospitalization. However, some populations may not be well-served by the traditional emergency department, particularly older adults, adults with serious illness, and those who are homebound. Many harms may come to older adults in the emergency department, including delirium, pressure injuries, infections, anxiety, and others. Emergency department crowding secondary to hospital capacity constraints may also lead to suboptimal care, as patients wait many hours for their inpatient bed even after a disposition decision is made.
As a result, the investigators will evaluate in a randomized controlled trial the efficacy of emergency care delivered at home instead of in the emergency department
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age >= 18 years
- •Resides within Home Hospital geographic area
- •Lives in permanent housing (i.e., not in temporary housing such as a shelter)
- •Patient of a Mass General Brigham primary care provider
- •Primary care provider attests that their triage recommendation is the emergency department
- •Emergency care at home nurse triages the participant to the emergency department or urgent care
- •Patient attests that they intend to go to the emergency department
排除标准
- •Insurance: workers compensation and motor vehicle accident
- •Lives in a healthcare facility (Skilled Nursing, Rehab, long term acute care)
- •Patient/caregiver cannot answer phone or door
- •Active substance use
- •Acute psychiatric concerns (e.g., suicidal ideation, even if passive)
- •Home safety concerns (e.g., intimate partner violence)
- •High-risk features:
- •oHigh Risk Signs, if available: Heart rate > 120 Systolic blood pressure < 90 Shock Index (heart rate divided by systolic blood pressure) > 1 Oxygen < 93% on ambient air Increase in oxygen requirement new or > 2 liters Respiratory rate > 28 Diaphoresis oHigh Risk Symptoms: Active chest pain Severe work of breathing Syncope Hemoptysis Seizure Other concerning symptom per nurse triage
- •Requires inpatient-level care
- •Requires specialty consultation
- •Requires physical, occupational, or speech therapy
- •Requires blood transfusion
- •Requires internal physical exam maneuver (e.g. rectal exam, genitourinary exam)
- •Requires imaging that is not available at home
- •Requires monitoring that is not available at home
- •Troubleshooting wound vacs
研究组 & 干预措施
Usual care
Emergency care in a brick-and-mortar emergency department.
干预措施: Emergency care at a brick-and-mortar emergency department (Other)
Emergency care at home
Emergency care in the patient's home.
干预措施: Emergency care at home (Other)
结局指标
主要结局
Participant with an emergency department presentation, observation, or hospitalization within 9 days
时间窗: From the day after emergency care visit until 9 days later, up to 9 days
Whether a patient presented to the emergency department, was observed in the emergency department, or was hospitalized in the 9 days following their index emergency care visit. Excludes patients who were admitted on their index visit.
次要结局
- Number of days at home within 9 days(From the day after emergency care visit until 9 days later)
- Time to care initiation(From the time a consultation is placed in the electronic health record to the time a patient is seen by a clinician, up to 2880 minutes.)
- Time spent receiving care(From the time a patient is seen by a clinician to the time a patient completes their emergency care, up to 1440 minutes.)
研究者
David Levine
Associate Physician
Brigham and Women's Hospital