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

Nicole M White; Xing J Lee; Michelle J Allen; Nicholas Graves; Gillian Harvey; Carla Shield; Trudy Dwyer; Claudia Meyer; Florin I Oprescu; Elizabeth V Cyarto; Jeffrey Rowland; Hannah E Carter

doi:10.1093/ageing/afaf275

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

Journal article

Open access

Peer reviewed

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

Nicole M White, Xing J Lee, Michelle J Allen, Nicholas Graves, Gillian Harvey, Carla Shield, Trudy Dwyer, Claudia Meyer, Florin I Oprescu, Elizabeth V Cyarto, …

Age and Ageing, Vol.54(10), pp.1-11

2025

DOI: https://doi.org/10.1093/ageing/afaf275

PMID: 41052261

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Abstract

hospital avoidance

nursing home

health service use

emergency transfer

aged care

older people

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).

Details

Title: The impact of a multi-component hospital avoidance programme in residential aged care homes: a stepped-wedge cluster randomised trial
Authors: Nicole M White - Queensland University of Technology
Xing J Lee - Queensland University of Technology
Michelle J Allen - Queensland University of Technology
Nicholas Graves - Duke-NUS Medical School
Gillian Harvey - Flinders University
Carla Shield - Queensland University of Technology
Trudy Dwyer - Central Queensland University
Claudia Meyer - Monash University
Florin I Oprescu - University of the Sunshine Coast
Elizabeth V Cyarto - Out Doors Inc (Australia)
Jeffrey Rowland - Prince Charles Hospital
Hannah E Carter (Corresponding Author) - Queensland University of Technology
Publication details: Age and Ageing, Vol.54(10), pp.1-11
Publisher: Oxford University Press
Date published: 2025
DOI: 10.1093/ageing/afaf275
ISSN: 1468-2834
PMID: 41052261
Copyright note: © The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Grant note: This study was funded by an Australian Medical Research Future Fund project grant (#1177501).
Organisation Unit: Engage Research Lab; School of Health - Public Health
Language: English
Record Identifier: 991168130402621
Output Type: Journal article

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Web Of Science research areas: Geriatrics & Gerontology

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