Emergency Care for Older People
Research type
Research Study
Full title
Identifying models of care to improve outcomes for older people with emergency and urgent care needs.
IRAS ID
262143
Contact name
Simon Conroy
Contact email
Sponsor organisation
University of Leicester
Clinicaltrials.gov Identifier
123005, R&D
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Research Summary
The aim of this study is to identify promising models of emergency department care that may improve outcomes for older people with urgent care needs.\n\nWe will observe care being delivered by health care professionals in 4-6 emergency departments in the Yorkshire & Humber region that exemplify different approaches. We will interview 60-120 clinicians, as well as managers and other staff, to understand what they are trying to achieve, how and why. There will be a specific focus upon identifying factors that enhance or conversely, impair, care delivery.\n\nThese observations and interactions will be analysed along with relevant documents (such as meeting minutes and policies), to create an overall view of what seems to help in getting these approaches to care to work well, and how such approaches might be used in other emergency department settings.
Summary of Results
Older people accessing emergency care have poor outcomes; this project aimed to:
• describe best practice in emergency care
• understand how best practice might be delivered
• describe current outcomes from emergency care, and
• synthesise this information in a computer simulation tool that can help teams decide which interventions might work best in their setting.
The existing literature showed that holistic interventions that span emergency and community care, designed with the needs of older people in mind, work best. We checked these findings with front line clinicians, who agreed, but identified that implementing best practice in the Emergency Department (ED) was challenging. Limitations included the ED environment itself and the lack of staff with the right skillset. We also asked older people and their carers who had recently received emergency care what mattered. They prioritised basic needs such as comfort, communication, and timely care. They also stated that getting better, maintaining their usual level of function, and getting home safely were important outcomes.
We then analysed data that linked together ambulance, ED, and hospital care in Yorkshire and Humber from 2011-2017 for over 1 million ED attendances and hospital admissions. We found a novel and accurate predictor of long ED waits and hospital admission: the level of urgency according to the ambulance call handler.
Drawing upon all the above and guided by a wide range of patient and professional stakeholders, we developed a computer model which allows emergency care teams to simulate different best practice ED interventions and estimate the impact on reducing admissions, readmissions, and hospital mortality.
In summary, we have reaffirmed the poor outcomes experienced by older people with urgent care needs. We have identified interventions that could improve patient and service outcomes, as well as implementation tools and strategies to transform emergency care for older people.REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
19/YH/0258
Date of REC Opinion
24 Sep 2019
REC opinion
Further Information Favourable Opinion