None listed
Conditions
Brief summary
Transfer of frail Residential Aged Care Facility (RACF) residents to Emergency Departments (ED) is common, risky and expensive. A nurse led ACE model together with telehealth video capability (PACE-IT) has the potential to optimise the benefits of both ACE and telehealth addressing avoidable RACF transfers. The project assesses whether the enhancement of ACE / ASET services through the addition of protocol guided interactive visual telehealth assessment and clinical decision-making, plus telephone follow-up, reduces RACF transfers to ED. No previous studies have reported the effectiveness of such an approach. The proposed intervention was piloted at JHH ED and 4 RACFs resulting in 40% of potential transfers being avoided.
Interventions
Intervention
This implementation study uses a stepped-wedge cluster randomised controlled design.
Sixteen RACFs (8 clusters) partnered with four hospital EDs are included. At regular time periods (steps) of 4 weeks, one RACF cluster (2 RACFs) will implement the intervention.
During the one month baseline study period 1, all clusters are in a control period. Data collection commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. ED data
Intervention This implementation study uses a stepped-wedge cluster randomised controlled design. Sixteen RACFs (8 clusters) partnered with four hospital EDs are included. At regular time periods (steps) of 4 weeks, one RACF cluster (2 RACFs) will implement the intervention. During the one month baseline study period 1, all clusters are in a control period. Data collection commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. ED data are aggregated monthly to indicate the number and outcomes of ACE/ASET calls and those assisted through the telehealth intervention. We will test for differences in ED presentations and hospital admissions between intervention and control periods. Existing Aged Care Emergency (ACE)/ Agedcare Services in Emergency Team (ASET) models will be strengthened and augmented with a novel Telehealth video linked interactive visual assessment and follow up phone call. This approach adds visual assessment capability and increases engagement and information exchange with residents, Residential Aged Care Facility (RACF) staff and families, if present. A video assessment and information sharing protocol will be initiated if a medical situation presents using the following steps: 1. Initial phone call or text from RACF to ACE/ASET nurse to log a request for consultation 2. Log requires provision of demographic and other relevant clinical data 3. ACE/ASET nurse responds with appointment for telehealth consultation 4. Telehealth video call from ACE/ASET nurse to RACF staff involving interactive visual assessment of the resident and shared decision making, with involvement of resident, staff and family members if present 5. If the resident is not transferred to ED or admitted to hospital a follow up phone call from the ACE/ASET nurse to RACF 24 hours post consultation will be attended to identify what alternative non hospital services were accessed and what treatment was delivered, and any adverse events 6. An electronic GP communication will be generated to summarise the reason for and outcome of the consultation. The visual link will be supported through Pexip in Hunter New England Local Health District (HNELHD) and Western NSW Local Health District (WNSWLHD). Telehealth is widely used in both LHDs, with HNELHD conducting 50% of State-wide telehealth consults annually (9453 telehealth appointments for 2018). Usual care (occurring prior to the stepped implementation of the intervention in each RACF) involves existing aged-care emergency service delivery models at each site with no telehealth consultation option.
Sponsors
Assoc Prof Michelle Giles
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Recruitment of residents only from the 16 participating RACFs. Involvement in the Visual Telehealth ACE call intervention Formal signed consent will not be sought from individual residents. This intervention will be embedded into normal practice. The already existing ACE model of care is augmented through the addition of Visual Telehealth ACE call, 24 hour follow-up phone call and consultation documentation summary to the RACF and GP. Residents and Carer Interviews Inclusion criteria 1. RACF residents in participating RACFs greater than 65 years old and who have participated in a Visual Telehealth ACE call. 2. Aboriginal residents in participating RACFs greater than 50 years old and who have participated in a Visual Telehealth ACE call. 3. A family member(s) involved in a Visual Telehealth ACE call.
Exclusion criteria
Residents with a cognitive impairment who are unable to provide an informed consent
Outcome results
None listed