From triage to departure: Older adults' ED journey. A mixed methods study.

Abstract

Background: Rising Emergency Department (ED) demand strains resources to assess and manage frail older adults. Allied health supports comprehensive care, disposition planning and patient safety in the ED but often intervenes late. This study investigated factors affecting allied health referrals and co-designed an early allied health frailty service.

Methods: An explanatory sequential mixed-methods approach was used. Patient journey mapping of low acuity older ED patients was followed by stakeholder focus groups.

Results: From triage, 20 older ED patients waited a mean of 110 minutes (SD 83 minutes) for doctor assessment, 123 minutes (SD 116 minutes) for an ED bed and 355 minutes (SD 297 minutes) for allied health assessment with a mean ED length of stay (LOS) of 685 minutes (SD 444 minutes). Qualitative analysis of focus group discussions identified perceived benefits of an early allied health service including shorter LOS, earlier disposition planning, increased staff confidence and streamlined decision making. Perceived barriers were lack of space, competing assessments with doctors and incomplete investigations. Perceived solutions were refining the inclusion criteria and staff education.

Conclusion: Allied health assessment occurred six hours post presentation, outside national targets. Opportunities and barriers identified supported the development of an earlier allied health frailty service.