Integrating personal support workers to support older adults in the emergency department: a quantitative analysis
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Updated: Nov 1, 2026
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Ivy Cheng1,2,3, Marina Motsenok4, Jean Sugarbroad5
1Sunnybrook Health Sciences Centre, Toronto, ON, Canada. isscheng@gmail.com.
Objective:
Our aim was to describe the pragmatic implementation of personal support workers in an ED setting, evaluating the characteristics of patients who were assigned to and received personal support worker care and the estimated operational impact of the program.
Methods:
This prospective observational cohort study was performed at a single ED during a pre (September 1/2022-February 28/2023) and post (March 11/2024-March 31/2025) intervention period. Requests were left to the discretion of any ED team member, including personal support workers. Using logistic regression, the primary outcome was patient characteristics. Secondary outcomes included in-hospital delirium rate, ED falls, ED length of stay using propensity score matching, and estimated redistribution of nursing hours with associated costs.
Results:
There were 26,757 and 60,737 ED visits made during the control and intervention periods. In the latter group, 6,039 (9.9%) visits received personal support worker care. The three characteristics most strongly associated with care were age ≥ 65 years (OR: 7.1, p<0.001), ambulance arrival (OR: 3.9, p<0.001), and higher acuity triage score (OR: 3.3, p<0.001). After matching the 6,039 personal support worker-attended visits to (1) control period visits and (2) non-personal support worker-attended visits during the intervention period, the personal support worker-attended group was associated with an increased rate of in-hospital delirium (2.2%-2.5%, p<0.001) and ED length of stay (8.5-13.4 h, p<0.001) in both comparisons, and a trend toward increased ED falls in the second comparison (0.1%, p=0.06). In the personal support worker-attended group, an estimated 9 h of nursing time and $287.01Cdn in costs were redistributed per day.
Conclusion:
Left to the discretion of the ED staff, patients receiving personal support worker care were older, had longer ED length of stay and higher rate of in-hospital delirium. Personal support worker care was associated with an estimated redistribution of nursing hours, which could be redirected toward providing acute medical care.
