Promoting DEmentia Friendly EmergeNcy DepartmentS: The effect of a hospital audit-directed action plan on adverse events in older people with cognitive impairment presenting to ED

Baseline audits will be undertaken within three participating hospital Emergency Departments (EDs) to inform the development of interventions at each site. This audit will occur over a 4-week period. An ED staff member will complete the Hospital Environment Audit Tool (HEAT), an evidence-based tool that provides practical strategies to optimise the environment in order to best meet the needs of older people and increase their participation in their care. All ED staff will be invited to complete a 10-15minute survey seeking their understanding of evidence-based strategies for the care of older people living with cognitive impairment and their carer/companion in ED. Questions will explore the perceived extent to which of evidence-based strategies are being applied in their ED setting and to prioritise areas for improvement. Fifty consecutive records for ED patients aged 60 and older who present to each ED site will be audited if their primary discharge diagnoses are coded as: confusion, hip fracture, delirium, or dementia. Records will be examined for adverse events in ED and processes related to discharge planning. ED staff will be invited to take part in a co-design process to improve the care environment for ED patients with cognitive impairment. The invitation will be extended to all ED staff and up to 8 staff who first express interest will be invited to attend three by one-hour meetings conducted over a 6-8 week period. At the first meeting, findings from the baseline audit will be summarised by the research team and presented to ED staff and ED staff will identify a priority area of concern to address. The second meeting will involve discussing possible solutions to the priority concern and drafting an intervention and action plan for implementation. The third meeting will review the action plan and reflect on any initial activities that have been undertaken and try to resolve barriers raised. ED staff, with support from the external research team, will identify a feasible action plan to implement within the three month intervention period and with the available funds to purchase equipment/environmental modifications. Funds from the research study have been allocated to each ED site to support data collection and small modifications. Therefore, the intervention will vary at each site to be responsive to local needs and priorities. The research team includes researchers with expertise in clinical care, dementia care and physical environments. It is envisaged that the intervention will focus on either environmental modification, support/information for carer/supporters of patients with cognitive impairment, and/or care processes to help support patients during their visit to the ED or to support their discharge (eg discharge information, follow-up care). Directly following the co-design phase of 6-8 weeks, each ED will implement the intervention for 3 months. After this three months we will survey ED staff to assess whether the intervention was implemented as planned as well as barriers and enablers to implementing the intervention. The survey will take approximately five minutes to complete. We will also conduct interviews with four patients and/or their supporter/family carers from each ED who attended the ED during the intervention period.