BackgroundThis study sought to determine whether early allied health intervention by a dedicated Emergency Department (ED) based team, occurring before or in parallel with medical assessment, reduces hospital admission rates amongst older patients presenting with one of ten index problems.MethodsA prospective non-randomized trial in patients aged sixty five and over, conducted in two Australian hospital EDs. Intervention group patients, receiving early comprehensive allied health input, were compared to patients that received no allied health assessment. Propensity score matching was used to compare the two groups due to the non-randomized nature of the study. The primary outcome was admission to an inpatient hospital bed from the ED.ResultsOf five thousand two hundred and sixty five patients in the trial, 3165 were in the intervention group. The admission rate in the intervention group was 72.0% compared to 74.4% in the control group. Using propensity score probabilities of being assigned to either group in a conditional logistic regression model, this difference was of borderline statistical significance (p = 0.046, OR 0.88 (0.76-1.00)). On subgroup analysis the admission rate in patients with musculoskeletal symptoms and angina pectoris was less for those who received allied health intervention versus those who did not. This difference was significant.ConclusionsEarly allied health intervention in the ED has a significant but modest impact on admission rates in older patients. The effect appears to be limited to a small number of common presenting problems.

Facilitated discharge of selected older adults by a CCT is relatively safe in the short term. Such patients have an increased likelihood of hospitalisation in the year after discharge. The 1 year mortality rate even in a 'low-risk' discharged population is 10%.

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation.

Aims: Allied health intervention may play an important role in the timely discharge of older people admitted to hospital. The impact of early allied health intervention on length of stay has not been quantified. We sought to determine whether early allied health intervention conducted in the emergency department (ED) reduces hospital length of stay in older patients admitted with common diagnoses. Methods: A non-randomised prospective pragmatic study in ED patients aged 65 and over diagnosed with one or more of six conditions (cerebrovascular insufficiency; fractured neck of femur; cardiac failure; myocardial ischaemia; exacerbation of chronic airways disease; respiratory tract infection). Intervention patients receiving comprehensive allied health assessment/intervention by at least one professional working in a care coordination team were compared with patients who underwent no assessment. The primary outcome measure was hospital length of stay measured in hours from commencement of inpatient bed occupancy to discharge or death. A zero truncated negative binomial regression model was used to analyse length of stay while adjusting for covariates. Results: In 2121 patients and 1451 comparators, there was no difference in length of stay (median 88 vs 87 h) on unadjusted (log-rank p 0.28) or adjusted (IRR 0.97, p 0.32) analysis. Conclusions: Front loading allied health assessment in ED has no effect on hospital length of stay. What's knownAllied health involvement in discharge planning is an important aspect of hospital care, and delays to allied health assessment can increase the length of stay in the inpatient setting. No prior studies quantifying the effect on length of stay of comprehensive allied health assessment in the emergency department have been conducted.