A nurse-led model of care within an emergency department reduces representation rates for frail aged care residents

  • Sophie ShrapnelEmail author
  • Elsa Dent
  • Caroline Nicholson
Short Communication



Hospital Emergency Departments (EDs) experience high presentation rates from older adults residing in Aged Care Facilities (ACFs), yet very few intervention studies have addressed the care needs of this population group. We designed and implemented a nurse-led model of care for older adults from ACFs, and determined its impact on patient outcomes.


This 12-month pre–post intervention study was conducted during 2013–2014, with follow-up during 2015–2016. Participants included all older adults presenting from ACFs to the ED of Mater Hospital Brisbane (MHB), Australia. Frailty status was determined using the Clinical Frailty Scale (CFS).


All participants were frail (n = 1130), with 19% severely frail, 55% very-severely frail, and 26% terminally ill. The intervention resulted in several improvements in patient outcomes, including significant reductions in ward admissions and 28-day representation rates.


Significant improvements can be achieved by integration of an acute frail older person service into an ED.


Emergency department Frailty Aged care facilities Model of care Aged 



In 2014, The Mater Hospital Brisbane funded one fulltime nursing position (SM) to implement the Mater Aged Care in an Emergency (MACIAE) study. ED is funded by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (#1112672).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ehical approval

The study was granted an exemption from the requirements for full Mater Health Services Human Research Ethics Committee (MHS HREC) review (HREC Ref No: HREC/15/MHS/44) as an audit of practice in accordance with the definition of research by the National Statement on Ethical Conduct of Human Research (2014).

Informed consent

Due to the pragmatic approach, a waiver of obtaining patient consent was approved by the ethics committee.


  1. 1.
    Pines JM, Mullins PM, Cooper JK et al (2013) National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc 61:12–17CrossRefGoogle Scholar
  2. 2.
    Dent E, Hoogendijk EO, Cardona-Morrell M et al (2016) Frailty in emergency departments. Lancet 387:434CrossRefGoogle Scholar
  3. 3.
    Dwyer R, Gabbe B, Stoelwinder JU et al (2014) A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 43:759–766CrossRefGoogle Scholar
  4. 4.
    Preston L, Chambers D, Campbell F et al (2018) Health Services and Delivery Research. What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review. NIHR Journals Library, Southampton (UK)Google Scholar
  5. 5.
    Brousseau AA, Dent E, Hubbard R et al (2018) Identification of older adults with frailty in the Emergency Department using a frailty index: results from a multinational study. Age Ageing 47:242–248CrossRefGoogle Scholar
  6. 6.
    O’Connell B, Hawkins M, Considine J, Au C (2013) Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp. Contempor Nurse 45:228–233CrossRefGoogle Scholar
  7. 7.
    Gruneir A, Cigsar C, Wang X et al (2018) Repeat emergency department visits by nursing home residents: a cohort study using health administrative data. BMC Geriatr 18:157CrossRefGoogle Scholar
  8. 8.
    Morphet J, Innes K, Griffiths DL et al (2015) Resident transfers from aged care facilities to emergency departments: can they be avoided? EMA 27:412–418PubMedGoogle Scholar
  9. 9.
    Graverholt B, Forsetlund L, Jamtvedt G (2014) Reducing hospital admissions from nursing homes: a systematic review. BMC Health Ser Res 14:36CrossRefGoogle Scholar
  10. 10.
    Fan L, Hou XY, Zhao J et al (2016) Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study. BMC Health Serv Res 16:46CrossRefGoogle Scholar
  11. 11.
    Australian Insititute of Health and Welfare. Older Australia at a glance Australia 2018. Accessed 8 Aug 2018
  12. 12.
    Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495CrossRefGoogle Scholar
  13. 13.
    van Walraven C, Dhalla IA, Bell C et al (2010) Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 182:551–557CrossRefGoogle Scholar
  14. 14.
    Karam G, Radden Z, Berall LE et al (2015) Efficacy of emergency department-based interventions designed to reduce repeat visits and other adverse outcomes for older patients after discharge: a systematic review. Geriatr Gerontol Int 15:1107–1117CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sophie Shrapnel
    • 1
    • 2
    Email author
  • Elsa Dent
    • 1
    • 2
    • 3
    • 4
  • Caroline Nicholson
    • 1
    • 2
  1. 1.Mater/UQ Centre for Integrated Care and Innovation, Mater Health ServicesSouth BrisbaneAustralia
  2. 2.Mater Research InstituteUniversity of QueenslandBrisbaneAustralia
  3. 3.Torrens University of AustraliaBrisbaneAustralia
  4. 4.Baker Heart and Diabetes InstituteMelbourneAustralia

Personalised recommendations