Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults
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Abstract
Older adults often visit the emergency department (ED) and face elevated rates of adverse events post-ED visits. This randomized controlled trial assessed the effects of early assessment and intervention by a specialized team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical efficacy of care for older adults.
Methods and Findings: This single-site randomized controlled trial involved 353 patients aged ≥65 years (mean age = 79.6, SD = 7.01; 59.2% female) presenting with lower urgency complaints at a university hospital during HSCP operational hours. The intervention comprised early assessment and intervention by an HSCP team including a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included ED revisits, hospital admissions from the ED, hospital length of stay for admitted patients, patient satisfaction, mortality, nursing home admission, unscheduled hospital admission at 30-day and 6-month follow-up, patient functional status, and quality of life. Demographic data included gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalization history. Participants in the intervention group (n = 176) had significantly shorter ED stays compared to the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED, higher satisfaction with the ED visit, better function at 30-day and 6-month follow-up, improved mobility at 30 days, and enhanced self-care at both follow-up points. No significant differences were observed in ED re-presentation or hospital admission at follow-up. Limitations include the inability to blind patients or ED staff due to the intervention's nature, and a focus on early assessment and intervention in the ED rather than post-discharge care integration.
Conclusions: Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and hospital admission risks among older adults while enhancing patient satisfaction. These findings support the effectiveness of an interdisciplinary care model for key ED outcomes
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