106 Optimising Early Assessment and Intervention by Health and Social Care Professions in the ED: Preliminary Findings from the OPTIMEND RCT

Older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. There is some evidence to suggest that Health and Social Care Professions (HSCP) teams working in the emergency department (ED) can enhance the care of older adults but the quality of these studies is mixed. This randomised controlled trial (Trial registration: NCT03739515) explores the impact of early assessment and intervention by an ED-based HSCP team on the quality, safety and cost-effectiveness of care of older adults.

Consecutive ED attendees aged ≥65 years were considered eligible for inclusion to the trial and were screened for eligibility based on pre-defined inclusion criteria. Participants were randomised to either early assessment/intervention by interdisciplinary team comprising a senior occupational therapist, senior physiotherapist and senior medical social worker or usual care. Primary outcomes included: ED length of stay and hospital admission rates. Secondary outcomes included: patient satisfaction, function, quality of life, incidence of ED re-visits, hospital admissions, nursing home admission, healthcare utilisation and mortality at 30-day and 6-month follow-up

Considering the first 140 participants, the intervention group spent significantly shorter time in the ED than the control group (7.5 vs. 15.2 median hours, p<0.001) and experienced lower admission rates (18.6% vs. 64.3%). At 30-day follow up, healthcare utilisation rates were higher in the intervention than control group (77.2% vs. 61.4%, p=0.04). There were no significant differences between the groups regarding satisfaction with their ED visit, function, quality of life of incidence of adverse outcomes at 30 days. Our cost-effectiveness analysis is ongoing.

Preliminary findings from our trial indicates that HSCPs working in the ED can contribute to improved older patients’ care by reducing their duration of stay in the ED and increasing rates of discharge home. Participant recruitment and six month follow-up is continuing.