Evaluating Pathways to Integrate Care using Exercise in the Emergency Department: A hybrid implementation effectiveness pilot study in patients with chronic conditions (EPIC-ED)

Screening & Consent: Patients are identified in the ED, provided with a flyer, and complete an online screening questionnaire. Eligible participants review the Participant Information and Consent Form (PICF) and provide consent via a secure online platform while still in hospital.Recruitment and Consent will occur at Box Hill Hospital Emergency Department (Victoria, Australia). Randomisation: After the initial survey, participants are randomised to either the referral or written advice group. Referral Group: One telehealth consultation (30–60 minutes), scheduled within 3 weeks post-discharge, with referral valid for up to 2 months post-discharge. The telehealth consultation is tailored to the participant’s specific health condition, needs, and goals. The advice provided by the Exercise Physiologist is individualised. The telehealth session may involve review of discharge results from emergency department, goal setting, and advice on exercise (for example frequency, intensity, duration, type). Participants randomised to the referral arm will be offered a referral for a telehealth consultation with an exercise physiologist from discharge by a member of the treating clinical team. All other treatment will be usual care. This approach has been selected to enable the treating clinician prioritisation of patient clinical needs and ensure that treatment decisions are in line with professional and ethical practice. The intervention whereby a referral is offered in the emergency department is informed by prior work involving qualitative interviews with patients, emergency medicine clinicians and allied health professionals in line with a participatory approach. Treatment conditions were informed by existing evidence and considered in consultation with Eastern Health’s Consumer Participation & Community Engagement team. Referrals made directly from emergency department clinicians as a result of the study will follow existing Eastern Health policies and procedures. Referrals are typically written into discharge plans with a copy sent to the patient’s general practitioner in accordance with the minimum requirements for referral to allied health. Accredited exercise physiologists have postgraduate qualifications in exercise assessment, programming, monitoring, and behaviour change for people with, or at risk of, a range of diseases/conditions, injuries, including physiological and psychological, cognitive or behavioural concerns. Participation in the exercise physiology consultation itself is not required as part of the study; rather, we are examining the outcomes of referral provision. Where patients choose not to use it, they can still participate in the surveys. The consultation will be provided optionally at no cost to the participant via in-kind contribution from Deakin University as a benefit of participating in the study. Prior to the appointment, participants are sent instructions via email on how to set up their device (computer or smartphone) for the telehealth session (via Zoom or Health Direct). Participants randomised to the telehealth referral group will be contacted by an exercise physiologist approximately 1- 2 weeks after ED discharge to schedule a telehealth consultation with the aim of completing the consultation by around 3 weeks post-discharge. Participants will not need to attend ongoing sessions. The consultation will be conducted via telehealth by an accredited exercise physiologist in line with the Digital Practice Standards for Ethical and Professional Practice, which emphasise a value-driven, person-centred approach. This approach was taken to minimise the impact of potential financial barriers to accessing healthcare for individuals with complex care needs. The approach will also provide insights into the value of referral for a single consultation, as a typical Medicare subsidised referral commonly supports between one and five sessions per year for eligible individuals. All Participants: All participants complete three brief online surveys (initial, 1-month, and 2-month follow-up) via secure links (each ~20 minutes). Follow-up: All participants complete follow-up surveys at 1 and 2 months post-discharge. Surveys include a validated measure of quality of life (EQ-5D-5L), physical activity (The Active Australia Survey) and a bespoke three-item patient questionnaire will measure health service utilisation in the past 1–2 months. Non-responders may be contacted by phone to complete or remind them about the survey. Medical Record Review: With consent, the research team accesses participants’ medical records to collect data on ED visits and healthcare usage. Adherence: Use of the referral and engagement with the factsheets is voluntary and self-directed. The protocol does not specify direct monitoring of adherence to the intervention itself, but follow-up surveys ask about healthcare use and engagement. Fidelity: The study assesses outcomes based on survey responses and medical record review. There is no direct observation or recording of the telehealth consultation, and no strategies are described for maintaining or improving fidelity beyond standardised referral and information provision.