Aged Residential Care Healthcare Implementation Project (ARCHIP). A multidisciplinary team (MDT) intervention package reduces emergency hospital presentations from Long Term Care (LTC)

Abstract

Introduction: The complexity of older people living in LTC facilities poses challenges often leading to potentially avoidable Emergency Department (ED) referrals. ARCHIP’s aim was to evaluate an MDT intervention supporting LTC facility staff to decrease potentially avoidable resident ED admissions. Methods: ARCHIP (conducted in 21 facilities [1,296 beds] with previously-noted high ED referral rates) comprised clinical coaching for LTC facility staff by gerontology nurse specialist (GNS) and MDT (facility senior nurse, resident’s general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents’ care-plans. A before-after repeated measures analysis of ED visits was conducted for facilities pre- and post-intervention. The sample included ED admissions 9 months before and 9 months after intervention commencement (29-month period in total because of staggered facility enrolment). Modelling adjusted for time trend, seasonality, facility size, and cluster effect. Results: ED admission rate ratio was 0.75 (95%C.I. 0.63,0.88, p-value = 0.0008), a 25% reduction in ED presentations post-intervention. A sensitivity model used a shorter, staggered time period centred on intervention start (9 months pre-intervention and 9 months postintervention) for each facility, and a four-level categorical intervention variable testing intervention effect over time. This showed a 24% reduction in ED presentations in months 1–3 post-intervention (p-value = 0.07), 34% reduction in months 4–6 (p-value = 0.01), and 32% reduction in ED presentations in months 7–9 (p-value = 0.03). When the higher rates for 3 months immediately pre-intervention were modelled, ED presentation rates reverted to previous levels. Key conclusions: GNS-led MDT outreach intervention decreases avoidable ED admissions of high-risk residents from selected facilities.