66Enhancing Older Patients’ Care in the Emergency Department: A Systematic Review of Interventions by Health and Social Care Professional Teams

Abstract

Background: Older adults are frequent users of emergency departments (EDs) and demonstrate high rates of adverse outcomes following emergency care. Evidence suggests that ED-based teams of health and social care professionals (HSCPs) can enhance quality of care, but no reviews exist that synthesise the totality of evidence on this model of care. This systematic review investigated the impact of HSCP teams working in the ED. Methods: We systematically searched CINAHL, Embase, the Cochrane Library and MEDLINE in March 2018 to identify studies describing early assessment and/or intervention offered to patients aged ≥18 years by ED teams involving at least one of the following HSCPs: occupational therapist, physiotherapist, clinical pharmacist, medical social worker, or speech and language therapist. We included randomised and nonrandomised controlled trials, controlled before-after studies, interrupted times series, and repeated measures studies. Two independent reviewers extracted data from each study and appraised study quality. Results: Nine studies were included in the review. Five studies focused exclusively on older adult populations with a range of index complaints. ED-based assessment of patients aged ≥65 years carried by HSCPs reduced unnecessary hospital admissions in two studies and improved referrals to community services for falls in one study. Early intervention by physiotherapists was linked to reduced ED length of stay in one study. Improved patient and staff satisfaction was reported in three studies. No significant changes emerged in ED re-visits (two studies) or costs (one study). A meta-analysis was not conducted due to heterogeneity across study designs, populations and outcomes measured. Conclusion: Our review provides some evidence that early HSCP assessment/interventions in the ED can enhance older patients' care. Further investigations are needed to clarify which specific older patient groups can benefit the most.