Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
Duke-NUS Postgraduate Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
BMC Geriatr. 2021 Jun 5;21(1):347. doi: 10.1186/s12877-021-02294-8.
Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia.
A stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers.
The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives.
The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry ( ACTRN12620000507987 , registered 23/04/2020).
居住在养老院的老年人经常被紧急转移到医院。这些事件与医院获得性并发症以及侵入性治疗或干预的风险有关。有证据表明，一些医院转院可能是不必要的或可以避免的。早期发现老年居民恶化（EDDIE）计划是一个多组件干预措施，旨在通过授权护理和护理人员来检测和管理居民恶化的早期迹象，从而减少养老院的不必要住院。本研究旨在在澳大利亚昆士兰州的一个多地点随机研究中实施和评估该计划。
将在 12 家养老院进行为期 58 周的分步楔形随机对照试验。该计划有四个组成部分：教育和培训、决策支持工具、诊断设备以及具有临床系统支持的实施促进。综合促进健康服务研究实施行动（i-PARIHS）框架将用于指导计划的实施和过程评估。主要结局指标将是居民使用的住院天数，次要结局指标将评估急诊转院率、入院率、住院时间、家庭意识和经验、员工自我效能和实施及卫生服务使用的成本。过程评估将评估计划实施的程度和保真度、影响机制以及背景障碍和促进因素。
预计该干预措施将通过减少不必要的医院转院来改善结果。减少不必要的医院转院和入院将为其他潜在需求更大的患者释放资源。养老院工作人员可能会因对主动管理居民恶化的早期迹象的能力感到有能力而受益。该过程评估将有助于支持更广泛地实施这一干预措施和其他类似举措。
该试验在澳大利亚和新西兰临床试验注册中心（ACTRN12620000507987，于 2020 年 4 月 23 日注册）进行了前瞻性注册。
