Reducing Hospital Transfers from Aged Care Facilities: A Large-Scale Stepped Wedge Evaluation

Area of Science:

• Gerontology
• Health Services Research
• Nursing

Background:

• Older adults in residential aged care facilities (RACFs) frequently experience acute health issues requiring emergency assessment.
• Hospital admissions and emergency department (ED) transfers from RACFs represent a significant burden on healthcare systems.
• Effective interventions are needed to manage acute deterioration within RACFs, improving resident outcomes and reducing healthcare utilization.

Purpose of the Study:

• To evaluate the impact of a large-scale, regional Aged Care Emergency (ACE) program on hospital admissions and ED transfers from RACFs.
• To assess the effectiveness of an integrated, nurse-led intervention designed to enhance the capacity of RACFs to manage acutely unwell residents.
• To determine if the ACE program can be successfully scaled to a broad geographic area.

Main Methods:

• A stepped wedge, nonrandomized cluster trial involving 81 RACFs and 9 hospital EDs across a large regional and rural area.
• Implementation of the ACE program, a nurse-led intervention including telephone support, algorithms, goal-setting, ED case management, and education.
• Collection and analysis of administrative data on ED transfers and hospital admissions over a 13-month baseline and 9-month follow-up period.

Main Results:

• A statistically significant reduction in hospital admissions (21% less likely) and ED transfers (20% less likely) was observed.
• The adjusted incident rate ratio for hospital admissions was 0.79 (95% CI: 0.68-0.92, P=.0025).
• The adjusted incidence rate ratio for ED visits was 0.80 (95% CI: 0.69-0.92, P=.0023), with reductions in 7-day ED re-presentations and 30-day hospital readmissions.

Conclusions:

• The Aged Care Emergency (ACE) program is a scalable, effective intervention for managing acute health deterioration in RACF residents.
• The program successfully reduced ED visits and hospitalizations, indicating improved care delivery within aged care settings.
• This nurse-led model demonstrates the potential to improve healthcare outcomes for older people with complex needs residing in RACFs.