A Pilot Randomised Controlled Trial Exploring the Impact of a Dedicated Health and Social Care Professionals (HSCP) Team in the Emergency Department on the Quality, Safety and Cost-effectiveness of Care for Older Adults
试验速览
- 阶段
- 不适用
- 入组人数
- 354
- 试验地点
- 2
- 主要终点
- ED length of stay
研究概览
简要总结
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.
详细描述
Background Internationally, emergency departments (EDs) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. Research demonstrates that ED crowding contributes to a reduction in the quality of patient care, delays in commencement of treatment and that adherence with recognised clinical guidelines worsens [1].
Identifying quality improvement strategies to improve patient flow in the ED can enhance quality of care. Evidence from international studies demonstrates that Health and Social Care Professionals (HSCPs) such as physiotherapists, occupational therapists and medical social workers can play a role in the ED in reducing length of patient stay, avoiding unnecessary hospital admissions and improving patient experience [2,3]. However, the quality of the evidence is mixed, primarily due to weaknesses in designing the studies.
Aim The overall aim of the study is to examine the impact of a dedicated team of Health and Social Care Professionals (HSCPs) in the Emergency Department (ED) on the quality, safety and cost-effectiveness of care of older adults in the ED.
The objectives of the study are as follows:
- To implement a HSCP team including a whole time equivalent senior physiotherapist (PT), senior occupational therapist (OT) and senior medical social worker (MSW) in the Emergency Department at University Hospital Limerick (UHL) for a period of six months.
- To examine if early assessment and intervention by the HSCP team improves the quality, safety and cost-effectiveness of care among older adults who present to the ED, as compared to usual care.
- To conduct a process evaluation of the HSCP intervention through focus group interviews with the HSCP team and representation from the wider ED staff regarding the implementation, delivery and impact of the intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
盲法说明
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.
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •≥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)
排除标准
- •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.
研究组 & 干预措施
HSCP team
Patients in this arm will receive comprehensive assessment and/or pre-discharge services by an ED-based HSCP team
干预措施: HSCP intervention (Other)
Routine care
Patients in this arm will receive routine ED care
干预措施: ED routine care (Other)
结局指标
主要结局
ED length of stay
时间窗: 1-24 hours (one day) after accessing the ED
Hours from ED admission to discharge
次要结局
- 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)
- Process evaluation(Within two months after completion of data collection (eight months after beginning of the study))
- Cost-effectiveness(Four months after index visit)
- Nursing home admission(30 days and six months after index visit)
- Mortality(30 days and six months after the index visit)
- Hospital admission rate(Within 72 hours of ED index visit)