ED PLUS Emergency Department Discharge Physiotherapy Led Community Service is a pilot feasibility randomized controlled trial investigating the role of an integrated care intervention consisting of comprehensive geriatrics assessment in older adults in the emergency department and a physiotherapy-led community based intervention.
All patients who are aged 65 years and over will be screened using the Identification of Seniors at Risk (ISAR) Tool in the emergency department of a University Teaching Hospital. Those with a score of 2 or above in the ISAR and suitable for discharge home will be randomised. The first treatment arm will undergo geriatric medicine item directed Comprehensive Geriatric Assessment (CGA) from admission to emergency department (ED). The non-treatment arm will under usual patient care. The second treatment arm will undergo geriatric medicine team directed CGA from admission to ED and a physiotherapy led community based 6 week intervention in the patient's home. A dedicated multidisciplinary team of geriatric medicine trainee, occupational therapist, physiotherapist and medical social worker will carry out the assessment. For those randomised to the second treatment arm, a physiotherapist will assess and carry out a 6 week interventions that arise from that assessment and liaise with the patients General Practitioner (GP), medical social worker and other health care professionals. The overall aims of ED PLUS are assess the feasibility of the 6 week physiotherapy led intervention. Feasibility will be determined by the following outcomes: i) Recruitment rate ii) Adherence rate iii) Acceptability of the programme iv) Retention v) Incidents The secondary aims are to improve function, reduce anxiety and depression, improve quality of life and prevent unnecessary ED admission.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
29
The intervention will involve a comprehensive geriatric assessment which will be provided by a geriatric doctor, physiotherapist, occupational therapist, social worker, pharmacist and specialist nurse.,
EDPLUS involves a 6 week physiotherapy led community based intervention involving 3 home visits and weekly telephone support.
University Hospital Limerick
Limerick, Ireland
Functional Decline
Barthel Index is global measure of functional status with a score from 0-20. A score of 0 is completely dependent, 20 is fully independent.
Time frame: 6 weeks post ED visit
Functional Decline
Barthel Index is global measure of functional status with a score from 0-20. A score of 0 is completely dependent, 20 is fully independent.
Time frame: 6 months post ED visit
Patient Quality of Life
Patient rated quality of life is determined by the Euro Quality of Life EQ5D. This scale is scored from 0 to 100 where 0 is the worst imaginable health state with 100 being the best imaginable.
Time frame: Baseline, 6 weeks post ED visit and 6 months post ED visit
Patient satisfaction
Patient satisfaction is determined by the Patient Satisfaction Survey III Short Form (PSQ18). This is scored from 18 to 90, with 18 being the lowest level of satisfaction to 90 being the best score
Time frame: Baseline, 6 weeks post ED visit and 6 months post ED visit
Rate of ED representation
A record of the patient coming back to the ED within 6 weeks and/or 6 months post ED index visit
Time frame: Baseline, 6 weeks post ED visit and 6 months post ED visit
Rate of Hospital readmission
A record of the patient requiring admission to the hospital within 6 weeks and/or 6 months
Time frame: Baseline,6 weeks post ED visit and 6 months post ED visit
Mortality
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A record of the patient having died within 6 weeks or 6 months
Time frame: 6 weeks post ED index visit or 6 months post ED index visit
Patient Experience Times
Exact time of admission or discharge form the ED will be collected at 6 weeks post ED index visit
Time frame: 6 weeks
Number of visits to the family doctor or public health nurse
Determined by self reported visits to family doctor or public health nurse. This will be a telephone consultation at 6 week and 6 months post ED index visit where patients will be asked if they have visited a family doctor or public health nurse in the previous 6 weeks at the 6 week telephone call, or 6 months at the 6 month telephone call
Time frame: 6 weeks and 6 months post index ED visit