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

Abstract

Background

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.

Methods

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).

Results

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.

Conclusion

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

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Acknowledgements

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).

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Correspondence to Sophie Shrapnel.

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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.

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Shrapnel, S., Dent, E. & Nicholson, C. A nurse-led model of care within an emergency department reduces representation rates for frail aged care residents. Aging Clin Exp Res 31, 1695–1698 (2019). https://doi.org/10.1007/s40520-018-1101-z

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Keywords

  • Emergency department
  • Frailty
  • Aged care facilities
  • Model of care
  • Aged