Conneely Mairéad, Leahy Aoife, O'Connor Margaret, Barry Louise, Corey Gillian, Griffin Anne, O'Shaughnessy Íde, O'Carroll Ida, Leahy Siobhán, Trépel Dominic, Ryan Damian, Robinson Katie, Galvin Rose
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
Pilot Feasibility Stud. 2022 Jan 3;8(1):3. doi: 10.1186/s40814-021-00954-5.
Older adults frequently attend the emergency department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. This paper reports a protocol designed to evaluate the feasibility of conducting a three arm randomised controlled trial (RCT) within the ED setting and in the patient's home. The interventions are comprehensive geriatric assessment (CGA), ED PLUS and usual care.
The ED PLUS pilot trial is designed as a feasibility RCT conducted in the ED and Acute Medical Assessment Unit of a university teaching hospital in the mid-west region of Ireland. We aim to recruit 30 patients, aged 65 years and over presenting to the ED with undifferentiated medical complaints and discharged within 72 h of index visit. Patients will be randomised by a computer in a ratio of 1:1:1 to deliver usual care, CGA or ED PLUS during a 6-month study period. A randomised algorithm is used to perform randomization. CGA will include a medical assessment, medication review, nursing assessment, falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and baseline cognition. ED PLUS, a physiotherapist led, multidisciplinary intervention, aims to bridge the transition of care between the index visit to the ED and the community by initiating a CGA intervention in the ED and implementing a 6-week follow-up self-management programme in the patient's own home following discharge from the ED. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively.
Rising ED visits and an ageing population with chronic health issues render ED interventions to reduce adverse outcomes in older adults a research priority. This feasibility RCT will generate data and experience to inform the conduct and delivery of a definite RCT.
The trial was registered in Clinical Trials Protocols and Results System as of 21 July 2021, with registration number NCT049836020 .
老年人经常前往急诊科就诊，且在急诊科就诊后出现不良后果的几率较高，包括功能衰退、再次前往急诊科就诊以及非计划住院。开发有效的干预措施以预防此类后果是研究和服务提供的关键优先事项。本文报告了一项旨在评估在急诊科环境和患者家中开展三臂随机对照试验（RCT）可行性的方案。干预措施包括综合老年评估（CGA）、急诊强化护理（ED PLUS）和常规护理。
急诊强化护理试点试验设计为一项在爱尔兰中西部地区一所大学教学医院的急诊科和急性医学评估单元进行的可行性随机对照试验。我们的目标是招募30名65岁及以上因未分化的医疗主诉前往急诊科就诊且在首次就诊后72小时内出院的患者。在为期6个月的研究期间，患者将通过计算机以1:1:1的比例随机分配接受常规护理、综合老年评估或急诊强化护理。使用随机算法进行随机分组。综合老年评估将包括医学评估、药物审查、护理评估、跌倒评估、活动能力和上下楼梯评估、转移评估、个人护理、日常生活活动（ADL）、社会支持和基线认知评估。急诊强化护理是一项由物理治疗师主导的多学科干预措施，旨在通过在急诊科启动综合老年评估干预，并在患者从急诊科出院后在其家中实施为期6周的随访自我管理计划，来弥合从急诊科首次就诊到社区护理过渡之间的差距。结果将是干预措施和试验方法可行性的参数，并将进行定量和定性评估。
急诊科就诊人数的增加以及患有慢性健康问题的老年人口的增长，使得减少老年人不良后果的急诊科干预措施成为研究重点。这项可行性随机对照试验将生成数据和经验，为确定的随机对照试验的开展和实施提供参考。
该试验于2021年7月21日在临床试验方案和结果系统中注册，注册号为NCT049836020 。
