Determining best practice for safe discharge of the older emergency patient.

Study 1

Systematic and structured grey literature review.

The aim of Study 1 is to identify clinical and cost effective models of care for older people presenting  to EDs and that are currently in place in national and international centres of excellence.

The key review questions will be:

  • What are the current models of care for older people in the ED?
  • How effective and efficient are the models of care identified?
  • What are the characteristics of successful models?
  • What are the barriers and enablers to effective interventions for older people presenting to the ED and/or short stay observation units?

The systematic review will follow NHMRC and Cochrane methods that will be defined a priori. An electronic search using appropriate MESH and key terms of the Medline, Embase, CIHAHL, and Psychlit, databases will be undertaken to identify relevant articles published between 1990 and 2011. Further studies will be identified from review of included article bibliographies. Terms for older people, aged care syndromes, emergency departments, short stay units, multidisciplinary care, geriatric care, coordinated care, transitional care and community care will be collated and combined with terms for models of care.

Studies will be included if they are systematic reviews, meta-analyses, randomised or cluster randomised clinical studies, controlled before and after studies or interrupted time series analyses. Settings will be included if they relate to management in emergency departments and/or short stay units. The patient population of interest will be older patients, aged 65 years or older.
Critical appraisal of study quality and potential for bias will be undertaken by a trained reviewer, with 20 per cent of articles being reviewed by a second independent assessor.
Data will be extracted into structured tables and summarised using NHMRC criteria.

It is anticipated there will be limited evidence for effective care models for older people in the ED in peer-reviewed literature. This secondary review will provide a pragmatic summary of current practice within centres of excellence, based on a structured web-based search. The project team will identify centres of excellence in care of older people in the ED in Australia and internationally. Care models identified by this search will be summarised to provide information about their structure and operational characteristics and associated policies.

Protocol_Effective_discharge_of_older_patients_from_the_ED.pdf292.6 KB