How to decrease ED admissions for high-risk residents in long-term care

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Michal Boyd reports on her new paper, Reducing emergency presentations from long-term care: A before-and-after study of a multidisciplinary team intervention, just published in  Maturitas. To download the paper: ARCHIP ED visits Maturitas 9-2018

Key conclusion: A Gerontology Nurse Specialist-led MDT outreach intervention, targeted at selected conditions, decreases avoidable ED admissions among high-risk residents.

The results of the Aged Residential Care Healthcare Integration Programme (ARCHIP) study show that gerontology nurse specialists (GNS) have an important role to play in decreasing potentially avoidable ED admissions of high-risk residents. This is a timely finding given the complexity of the conditions older people are  living with in long-term care facilities, especially as the population ages.

The aim of ARCHIP was to evaluate a multidisciplinary (MDT) intervention to support staff in long-term care facilities to decrease potentially avoidable resident ED admissions. It was offered to facilities with previously noted high ED referral rates and consisted of clinical coaching for long-term facility staff by a gerontology nurse specialist (GNS). It also included a MDT review where selected high-risk residents’ plans of care were discussed. MDTs comprised facility senior nurse, resident’s general practitioner, GNS, a geriatrician and a clinical pharmacist.

A before-after repeated measures analysis of ED visits was conducted for facilities pre and post intervention. Twenty-one facilities, representing 1,296 beds 9 months before and 9 months after the start of the intervention period took part. The model was adjusted for time trend, seasonality, facility size, and cluster effect.

The ED admission rate ratio was found to be 0.75 with 95% C.I. [0.63, 0.88, p-value 0.0008], a 25% reduction in ED presentations following the intervention. When the higher rates in the 3-month period immediately prior to the intervention start were disregarded, ED presentation rates reverted to previous levels.

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