- Title
- Partnerships in aged care emergency services using interactive telehealth (PACE-IT)
- Creator
- Sunner, Carla
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Transferring residential aged care facility residents to emergency departments (EDs) to access assessment and care for unplanned/acute health events is expensive, with up to 75% of residents transferred to EDs annually, exposing them to iatrogenic harm. The aged care emergency service in the ED provides outreach telephone support to residential aged care facility nurses to help improve decision-making and enable residents to remain in their homes when appropriate. Aim: The Partnerships in Aged Care Emergency Services using Interactive Telehealth (PACE-IT) study aims to assess whether the augmentation of the telephone-based residential aged care facility emergency service with the addition of a visual telehealth consultation would reduce resident transfers to the ED compared to usual care. Study design: A stepped wedge cluster randomised controlled trial was conducted in four public hospital EDs and 16 residential aged care facilities with 1,435 beds (mean = 87) in two local health districts in New South Wales (NSW), Australia. The study was powered to detect a 30% reduction in the primary outcome—transfers to the ED. Visual telehealth was added to an existing telephone based, Aged Care Emergency nurse-led outreach service unique to Hunter New England (HNE) Local Health District (LHD). Methods: Feasibility and acceptability data were collected from focus groups, interviews and a survey of residential aged care facility nurses, together with primary outcome data extracted from electronic ED patient management systems from March 2020 to April 2021. Due to COVID-19, study commencement was delayed for many months. During this time, a qualitative study was undertaken to explore the COVID-19 preparedness of residential aged care facilities using in-depth interviews with 28 managers. Data analysis: Primary outcome ED presentation data to identify residents transferring from participating residential aged care facilities to ED were compared between intervention and control periods using a generalised linear mixed effects regression model. Secondary outcome data on feasibility and acceptability and the residential aged care facility manager interviews were analysed using Thorne’s (2016) Interpretive Descriptive methodology. Results: The COVID-19 preparedness study with residential aged care facility managers highlighted the urgent need for better pandemic response planning and management to meet residents’ unprecedented healthcare and safety challenges. Compared to pre-implementation, post-implementation of PACE-IT found a non- statistically significant 29% reduction (incidence rate ratio = 0.71 [95% CI 0.46, 1.09]) in ED presentations (per 100 residential aged care facility beds) that occurred within ED aged care emergency hours. A post hoc logistic regression demonstrated a significant 69% reduction (odds ratio 0.31 [95% CI 0.11, 0.87]) in ED presentations within ED aged care emergency hours. A review of the PACE-IT model of care’s (MOC) long-term sustainability, feasibility and acceptability identified further resourcing needs. Conclusion: The PACE-IT study has shown the feasibility and impact of visual telehealth communication between residential aged care facilities and the ED in reducing the unnecessary transfer of residents to EDs. These reductions are clinically important and impactful for residents and EDs. Sustainability of the PACE-IT MOC requires further investment in workforce and information technology resources in both residential aged care facilities and EDs to realise these benefits more broadly. The healthcare system as a whole will gain greatly from any decrease in resident presentations to a busy ED—especially for the individual older person who can recover safely in their residential aged care facility. This decrease will also aid in overcoming some of the challenges during a pandemic.
- Subject
- emergency department; residential aged care facilty; bidirectional communication; implementation science; patient safety; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1497157
- Identifier
- uon:54304
- Rights
- Copyright 2024 Carla Sunner
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 26 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 394 KB | Adobe Acrobat PDF | View Details Download |