. 2021 Jun 5;21(1):347.

doi: 10.1186/s12877-021-02294-8.

A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol

Hannah E Carter¹, Xing J Lee², Alison Farrington², Carla Shield², Nicholas Graves^{2

3}, Elizabeth V Cyarto^{4

5

6}, Lynne Parkinson⁷, Florin I Oprescu⁸, Claudia Meyer^{4

9

10}, Jeffrey Rowland^{11

12

13}, Trudy Dwyer¹⁴, Gillian Harvey^{2

15}

Affiliations

¹ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia. hannah.carter@qut.edu.au.
² Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
³ Duke-NUS Postgraduate Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
⁴ Bolton Clarke Research Institute, 347 Burwood Hwy, Forest Hill, Victoria, 3131, Australia.
⁵ Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
⁶ Department of Psychiatry, University of Melbourne, Parkville, VIC, 3010, Australia.
⁷ School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
⁸ School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia.
⁹ Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Victoria, 3199, Australia.
¹⁰ Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, 3083, Australia.
¹¹ Faculty of Medicine, University of Queensland, 20 Weightman St, Herston, QLD, 4006, Australia.
¹² Faculty of Health, School of Nursing, Kelvin Grove Campus, Queensland University of Technology, Brisbane, Australia.
¹³ Metro North Health, Royal Brisbane and Women's Hospital, 7 Butterfield St, Herston, QLD, 4029, Australia.
¹⁴ School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, 4702, Australia.
¹⁵ College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia, 5042.

PMID: 34090368
PMCID: PMC8179705
DOI: 10.1186/s12877-021-02294-8

A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol

Hannah E Carter et al. BMC Geriatr. 2021.

. 2021 Jun 5;21(1):347.

doi: 10.1186/s12877-021-02294-8.

Authors

Affiliations

¹ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia. hannah.carter@qut.edu.au.
² Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
³ Duke-NUS Postgraduate Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
⁴ Bolton Clarke Research Institute, 347 Burwood Hwy, Forest Hill, Victoria, 3131, Australia.
⁵ Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
⁶ Department of Psychiatry, University of Melbourne, Parkville, VIC, 3010, Australia.
⁷ School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
⁸ School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia.
⁹ Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Victoria, 3199, Australia.
¹⁰ Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, 3083, Australia.
¹¹ Faculty of Medicine, University of Queensland, 20 Weightman St, Herston, QLD, 4006, Australia.
¹² Faculty of Health, School of Nursing, Kelvin Grove Campus, Queensland University of Technology, Brisbane, Australia.
¹³ Metro North Health, Royal Brisbane and Women's Hospital, 7 Butterfield St, Herston, QLD, 4029, Australia.
¹⁴ School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, 4702, Australia.
¹⁵ College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia, 5042.

PMID: 34090368
PMCID: PMC8179705
DOI: 10.1186/s12877-021-02294-8

Abstract

Background: Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia.

Methods: A stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers.

Discussion: The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives.

Trial registration: The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry ( ACTRN12620000507987 , registered 23/04/2020).

Keywords: Acute care; Deterioration; Early detection; Economic evaluation; Elderly; Emergency department; High value care; Hospital transfer; Nursing home; Residential aged care facility.

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Conflict of interest statement

None to declare.

Figures

**Fig. 1**
Stepped-wedge study design in 12 RAC homes

**Fig. 2**
EDDIE+ intervention components and mechanisms of impact

See this image and copyright information in PMC

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A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol

Affiliations

A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical