Geriatric-led transitional care for older adults discharged from the emergency department: impact on hospital readmissions and disability. Protocol for the controlled prospective quasi-experimental study LASUITE.

Background: Even when older people are discharged directly home after an emergency department (ED) visit, the risk of deterioration of health status and loss of independence persists. We hypothesize that among older adults discharged from the ED, hospital-community transition care provided by geriatric mobile teams (GMTs) may reduce the early readmission rate and level of disability. Such approaches have rarely been evaluated and cannot be generalized yet. Providing evidence of the positive impact of these strategies may influence public health policies.

Methods: We will conduct a national, multicentre, prospective, controlled, quasi-experimental study. All participating centres have an ED and a GMT, some of which provide transitional care. Participants recruited from hospitals where GMT provide transitional care form the "intervention group", whereas participants recruited from hospitals where GMT provide standard in-hospital management are the "control group". Inclusion criteria are age ≥ 75 years, returning to personal home after the ED visit (exclusion of nursing home residents) and having a significant risk for early readmission and/or loss of independence after discharge according to a Triage Risk Screening Tool score ≥ 2. The primary objective of this study is to compare hospital ED readmission rates within 30 days. Among secondary objectives, disability scores at 3 and 6 months will be compared between groups. We estimated that 1322 participants, i.e., 661 per group, is required for the main analysis.

Discussion: By conducting this study, we aim to provide more evidence of the effectiveness of transitional care on reducing ED readmissions for older adults, and particularly highlight determinants and effects of hospital-community GMT-led interventions. These strategies can be cost-effective while preserving independence and quality of life. We expect that the results will provide a basis to generalize effective strategies to address the challenges of demographic ageing for healthcare systems.

Trial registration: The study protocol was registered on ClinicalTrial.org (ID NCT05814328 Date 20230414).