The impact of a multi-component hospital avoidance programme in residential aged care homes: a stepped-wedge cluster randomised trial

Abstract

Objectives To investigate if a multi-component hospital avoidance intervention would reduce hospital bed days in residential aged care (RAC) homes. Design Prospective stepped-wedge cluster randomised trial with usual care and intervention phases. Setting Eleven RAC homes in Queensland, Australia. Participants The intervention targeted all nursing staff and personal care workers within the participating RAC homes. Outcome data were collected for all residents living in the participating RAC homes at any time throughout the trial period. Intervention The intervention comprised four core components: face-to-face training sessions with all nursing staff and personal care workers; provision of diagnostic medical equipment; decision support tools and embedded implementation facilitation and support. Main outcome measures The primary outcome was the number of hospital bed days per 100 resident days in RAC homes. Secondary outcomes assessed emergency department (ED) transfers, subsequent admissions to hospital and hospital length of stay. Results No statistically significant intervention effects were observed across the reported outcomes. Exposure to the early detection of deterioration in elderly residents intervention was associated with a 27% relative increase in the primary outcome of hospital bed days (Estimate, 95% CI: 1.13, 0.93–1.74, P-value = 0.137). There was an 8% reduction in ED transfers (Estimate, 0.92: 0.74–1.14, P-value = 0.462) and a 10% increase in hospital admissions (Estimate, 1.10, 95% CI: 0.84–1.44, P-value = 0.486). For residents admitted to the hospital, the expected length of stay increased from 4.2 to 4.4 days (Estimate: 1.04; 95% CI: 1.00–1.07; P-value = 0.055). Conclusions Whilst not statistically significant, findings indicate that the intervention was associated with fewer ED transfers, but increased hospital admissions and overall hospital bed days. Programme implementation was impacted by major contextual barriers, notably the COVID-19 pandemic, which contributed to pressures on staffing and workload. Trial registration Australia New Zealand Clinical Trial Registry, ACTRN12620000507987 (registered 23rd April 2020).