A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Abstract

The aim of this randomised controlled trial involving 224 elderly patients was to determine whether early geriatric assessment (in the form of an aged care nurse intervention based in the emergency department) reduced admission to the hospital, length of inpatient stay (LOS), or functional decline during the hospitalisation. Baseline geriatric assessments were recorded in the medical files of intervention patients (n = 114). The nurse also liaised with the patients' carers and health care providers, organised referrals for out-of-hospital assessment and support services, and assisted in the care of those admitted as inpatients by documenting suggestions for assessment and referral. Assessment data from control patients (n = 110) were withheld, and the nurse had no further involvement in their inpatient or outpatient care. One hundred and seventy-one patients (76%) were admitted to the hospital, for a median LOS of 10 days. The nurse successfully identified those needing admission (odds ratio [OR], 14.0; 95% confidence interval [CI], 2.6-75.1). Thirty-nine of 160 inpatients with available data (24%) had a functional deterioration during the hospitalisation. The intervention had no significant effect on admission to the hospital (OR, 0.7; CI, 0.3-1.7), LOS (hazard ratio, 1.1; CI, 0.7-1.5) or functional decline during the hospitalisation (OR, 1.3; CI, 0.5-3.3).