Partnerships in Aged-Care Emergency services using Interactive Telehealth (PACE-IT) incorporating telehealth visual assessment, information sharing and decision making for people living in residential aged-care facilities (RACF)

INTERVENTION: Intervention This implementation study uses a stepped‐wedge cluster randomised controlled design. Sixteen RACFs (8 clusters) partnered with four hospital EDs are included. At regular time periods (steps) of 4 weeks, one RACF cluster (2 RACFs) will implement the intervention. During the one month baseline study period 1, all clusters are in a control period. Data collection commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. ED data are aggregated monthly to indicate the number and outcomes of ACE/ASET calls and those assisted through the telehealth intervention. We will test for differences in ED presentations and hospital admissions between intervention and control periods. Existing Aged Care Emergency (ACE)/ Agedcare Services in Emergency Team (ASET) models will be strengthened and augmented with a novel Telehealth video linked interactive visual assessment and follow up phone call. This approach adds visual assessment capability and increases engagement and information exchange with residents, Residential Aged Care Facility (RACF) staff and families, if present. A video assessment and information sharing protocol will be initiated if a medical situation presents using the following steps: 1. Initial phone call or text from RACF to ACE/ASET nurse to log a request for consultation 2. Log requires provision of demographic and other relevant clinical data 3. ACE/ASET nurse responds with appointment for telehealth consultation 4. Telehealth video call from ACE/ASET nurse to RACF staff involving interactive visual assessment of the resident and shared decision making, with involvement of resident, staff and family members if present 5. If the resident is not transferred to ED or admitted to hospital a follow up phone call from the ACE/ASET nurse to RACF 24 hours post consultation will be attended to identify what alternative non hospital services were accessed and CONDITION: Emergency care intervention ;Older patients;Dementia;Frail elderly;Vulnerable population;Chronic illness; ; Emergency care intervention; ; Older patients ; Dementia ; Frail elderly ; Vulnerable population ; Chronic illness Emergency medicine ‐ Other emergency care PRIMARY OUTCOME: ED presentations by RACF residents as assessed by audit of Emergency ; Department presentation records; [Data collection commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. The ED presentation data will be aggregated for each RACF per month, and the rate of ED presentations (per RACF beds) will be compared between intervention and control periods using a generalised linear mixed effects regression model (Poisson or negative binomial with a log link). ; ] SECONDARY OUTCOME: Acceptability and uptake of the intervention by ACE‐ASET staff via focus group meetings pre and post implementation.[3 month post implementation.] Acceptability and uptake of the intervention by RACF residents and family interviews [3 months post implementation. ; ] Acceptability and uptake of the intervention by RACF staff survey based on Likert Scale and Focus group meetings [1. Survey attended immediately post telehealth consultation for 3 months post implementation ; 2. Focus groups 3 months post commencement of implementation ; ] INCLUSION CRITERIA: Recruitment of residents only from the 16 participating RACFs. Involvement in the Visual Telehealth ACE call intervention Residents and Carer Interviews Inclusion criteria 1. RACF residents in participating RACFs greater than 65 years old and who have participated in a Visual Telehealth ACE call. 2. Aboriginal residents in participating RACFs greater than 50 years old and who have participated in a Visual Telehealth ACE call. ; ] Health care associated costs related to hospital admissions post telehealth call data collected via Emergency Department presentation records. [Commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. ; ] Monitoring adverse events and safety of resident via a follow up phone call for every telehealth consultation. [ Follow up phone call within 24 hours of telehealth consultation. Data collection commences in period 1 through to period 10, ie one month post implementation of the intervention in all clusters. Formal signed consent will not be sought from individual residents. This intervention will be embedded into normal practice. The already existing ACE model of care is augmented through the addition of Visual Telehealth ACE call, 24 hour follow‐up phone call and consultation documentation summary to the RACF and GP. 3. A family member(s) involved in a Visual Telehealth ACE call.