Journal article
Implementing an intervention to facilitate early detection of deterioration in aged care residents: process evaluation of the EDDIE + trial
Implementation Science, Vol.21, pp.1-13
2026
PMID: 41699697
Abstract
Background
EDDIE + was a stepped wedge cluster randomised controlled trial with an embedded process evaluation in 11 residential aged care (RAC) homes in Queensland, Australia. The intervention aimed to upskill RAC staff to identify and manage deterioration to reduce unnecessary hospital transfer through education, decision support tools, diagnostic equipment and local facilitation. Main trial results indicated 46% of hospital admissions were due to falls and no significant improvements to outcome measures including hospital bed days were achieved. These findings were examined through a process evaluation.
Methods
A mixed methods approach guided by the i-PARIHS framework was used to assess fidelity, acceptability, mechanisms of impact and feasibility of implementation, including barriers and enablers. Semi-structured interviews, self-efficacy surveys, and project tracking documents were used. Qualitative data were coded to the i-PARIHS framework and quantitative data were analysed using linear mixed modelling.
Results
Fidelity varied considerably due to workforce shortages including vacancy in the local clinical facilitator role, high workload, COVID-19, and other contextual factors. Differences in job and team-related staff self-efficacy before and after the introduction of EDDIE + were not statistically significant. However, inductive thematic analysis of the questionnaires indicated that staff felt their knowledge, skills, confidence and communication had increased.
Conclusions
The process evaluation indicates high acceptability of the EDDIE + intervention. However, fidelity and intended mechanisms of impact were mixed despite substantial pre-planning prior to implementation. For future studies, specific barriers in the RAC setting such as staffing and turnover may be unable to be adequately addressed without systemic change.
Trial registration
The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
Details
- Title
- Implementing an intervention to facilitate early detection of deterioration in aged care residents: process evaluation of the EDDIE + trial
- Authors
- Ella L Bracci (Corresponding Author) - Flinders UniversityMichelle J Allen - Queensland University of TechnologyHannah E Carter - Queensland University of TechnologyElizabeth Cyarto - Queensland University of TechnologyTrudy Dwyer - Central Queensland UniversityAlison Farrington - Queensland University of TechnologyNicholas Graves - Queensland University of TechnologyXing J Lee - Queensland University of TechnologyClaudia Meyer - Monash UniversityFlorin Oprescu - University of the Sunshine Coast, Queensland, School of Health - Public HealthJeffrey Rowland - Prince Charles HospitalCarla Shield - Queensland University of TechnologyNicole White - Queensland University of TechnologyGillian Harvey - Queensland University of Technology
- Publication details
- Implementation Science, Vol.21, pp.1-13
- Publisher
- BioMed Central Ltd.
- Date published
- 2026
- DOI
- 10.1186/s13012-026-01484-5
- ISSN
- 2662-2211
- PMID
- 41699697
- Copyright note
- This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
- Data Availability
- The data is available from the corresponding author upon reasonable request.
- Organisation Unit
- Healthy Ageing Research Cluster; Engage Research Lab; School of Health - Public Health
- Language
- English
- Record Identifier
- 991212681202621
- Output Type
- Journal article
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