An emergency department transitional care team prevents unnecessary hospitalization of older adults: a mixed methods study

IntroductionOlder adults with acute functional decline may visit emergency departments (EDs) for medical support despite a lack of strict medical urgency. The introduction of transitional care teams (TCT) at the ED has shown promise in reducing avoidable admittances. However, the optimal composition and implementation of TCTs are still poorly defined. We evaluated the effect of TCTs consisting of an elderly care physician (ECP) and transfer nurse versus a transfer nurse only on reducing hospital admissions, as well as the experience of patients and caregivers regarding quality of care.MethodsWe assessed older adults (>= 65 years) at the ED with acute functional decline but no medical indication for admission. Data were collected on type and post-ED care, and re-visits were evaluated over a 30-day follow-up period. Semi-structured interviews with stakeholders were based on the Consolidated-Framework-for-Implementation-Research, while patient and caregiver experiences were collected through open-ended interviews.ResultsAmong older adults (N = 821) evaluated by the TCT, ECP and transfer nurse prevented unnecessary hospitalization at the same rate (81.2%) versus a transfer nurse alone (79.5%). ED re-visits were 15.6% (ECP and transfer nurse) versus 13.5%. The interviews highlighted the added value of an ECP, which consisted of better staff awareness, knowledge transfer and networking with external organizations. The TCT intervention in general was broadly supported, but adaptability was regarded as an important prerequisite.ConclusionRegardless of composition, a TCT can prevent unnecessary hospitalization of older adults without increasing ED re-visiting rates, while the addition of an ECP has a favourable impact on patient and professional experiences. 1) Establishing a transitional care team at the emergency department (ED) reduced unnecessary hospital admissions among community-dwelling older adults.2) The composition of the transitional care team did not affect the number of avoidable hospital admissions and ED re-visits, with similar results for a transfer nurse alone versus a transfer nurse supported by an elderly care specialist (ECP).3) Having an ECP in the transitional care team positively impacted the quality of care experienced by patients, caregivers and professionals.4) Patients and family members very much appreciated that the ECP and transfer nurse took a holistic approach, had more time and were available to help, support or organize aftercare.