BACKGROUND Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED. METHODS AND FINDINGS This single-site randomised controlled trial included a sample of 353 patients aged ≥65 years (mean age = 79.6, SD = 7.01; 59.2% female) who presented with lower urgency complaints to the ED a university hospital in the Mid-West region of Ireland, during HSCP operational hours. The intervention consisted of early assessment and intervention carried out by a HSCP team comprising a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included rates of hospital admissions from the ED; hospital length of stay for admitted patients; patient satisfaction with index visit; ED revisits, mortality, nursing home admission, and unscheduled hospital admission at 30-day and 6-month follow-up; and patient functional status and quality of life (at index visit and follow-up). Demographic information included the patient's gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalisation history. Participants in the intervention group (n = 176) experienced a significantly shorter ED stay than the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED (19.3% versus 55.9%, p < 0.001), higher levels of satisfaction with the ED visit (p = 0.008), better function at 30-day (p = 0.01) and 6-month follow-up (p = 0.03), better mobility (p = 0.02 at 30 days), and better self-care (p = 0.03 at 30 days; p = 0.009 at 6 months). No differences at follow-up were observed in terms of ED re-presentation or hospital admission. Study limitations include the inability to blind patients or ED staff to allocation due to the nature of the intervention, and a focus on early assessment and intervention in the ED rather than care integration following discharge. CONCLUSIONS Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and the risk of hospital admissions among older adults, as well as improving patient satisfaction. Our findings support the effectiveness of an interdisciplinary model of care for key ED outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03739515; registered on 12 November 2018.

中文翻译：

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急诊科健康和社会护理专业团队的评估和干预对老年人护理质量、安全性和临床有效性的影响：一项随机对照试验。


背景技术老年人经常去急诊科(ED)，并且在急诊科就诊后出现不良事件的几率很高。这项随机对照试验评估了急诊科专门的健康和社会护理专业人员 (HSCP) 团队的早期评估和干预对急诊科老年人护理质量、安全性和临床有效性的影响。方法和结果 这项单中心随机对照试验纳入了 353 名年龄≥65 岁的患者样本（平均年龄 = 79.6，SD = 7.01；59.2% 为女性），这些患者向中部地区一家大学医院的急诊科提出了较低紧急程度的主诉。爱尔兰西部地区，HSCP 运行时间内。干预包括早期评估和由高级医务社工、高级职业治疗师和高级物理治疗师组成的 HSCP 团队进行的干预。主要结局是急诊科住院时间。次要结果包括急诊室入院率；入院患者的住院时间；患者对初次就诊的满意度； 30 天和 6 个月随访时的急诊复诊、死亡率、疗养院入院和非计划入院情况；患者的功能状态和生活质量（首次访视和随访时）。人口统计信息包括患者的性别、年龄、婚姻状况、居住状况、到达急诊室的方式、转诊来源、主诉、分诊类别、跌倒和住院史。干预组参与者 (n = 176) 的 ED 停留时间明显短于对照组 (n = 177)（中位时间为 6.4 小时与 12.1 小时，p < 0.001）。其他显着差异（干预与对照）包括急诊室入院率较低（19.3% 与 55.9%，p < 0.001)，对急诊就诊的满意度更高 (p = 0.008)，30 天 (p = 0.01) 和 6 个月随访 (p = 0.03) 时功能更好，更好的活动能力（30 天时 p = 0.02）和更好的自我护理（30 天时 p = 0.03；6 个月时 p = 0.009）。随访时在急诊科复诊或入院方面没有观察到差异。研究的局限性包括由于干预的性质而无法对患者或急诊室工作人员进行盲法分配，以及重点关注急诊室的早期评估和干预，而不是出院后的护理整合。结论 由专门的急诊室 HSCP 团队进行早期评估和干预可以减少老年人的急诊住院时间和住院风险，并提高患者满意度。我们的研究结果支持跨学科护理模式对急诊科关键结局的有效性。试验注册 ClinicalTrials.gov NCT03739515； 2018年11月12日注册。