[FG] Nursing Science (INS)

Imported from Grants Tool 4707568

RemEDy (Reducing Mistriage in Emergency Departments)

The demand for emergency care varies and can change rapidly. Emergency Department (ED) performance depends on the number of patients who present, and their flow through the ED to their safest and most appropriate disposition (admission to tertiary care, referral to one of the partnering hospitals, or discharge). Effective triage is critical for the safe management of patients presenting to the ED, ensuring the right patient receives the right care at the right time in the right place with the right resources. Despite the recognized importance of accurate triage of emergency department patients, approximately 20% to 30% experience incorrect triage level assignment, known as mistriage. Mistriage might be associated with adverse health outcomes. To enhance triage accuracy, it is crucial to understand the causes of mistriage and how they are associated with the characteristics of patients, triage clinicians, and ED metrics. A comprehensive understanding of mistriage will allow for the identification of potential areas for improvement, leading to the development of measures to avoid it. RemEDy (Reducing Mistriage in Emergency Departments) will identify and analyze mistriage in a real-time triage setting in 7 ED’s in German-speaking Switzerland, comparing routine triage procedures with expert triage simultaneously, and develop and evaluate an AI model that can potentially assist with triage decisions, aiming to detect patients who should not wait early. Based on the results, we will develop a learning module for triage clinicians and assess its effectiveness in reducing mistriage. This could result in enhanced accuracy in triage code assignment, thereby reducing mistriage and its associated consequences.

Background and rationale for project

Frailty is a major public health challenge. Frailty is a multidimensional syndrome in which a person accumulates impairments in multiple life domains due to ageing. Examples include physical impairments (e.g. reduced mobility), social status (e.g. social isolation) and cognition impairment. Frailty predisposes a person to negative health outcomes and is associated with long-term disability, a lower quality of life, and high costs. As impairments accumulate, persons are less able to participate in society, interact with their direct environment, and become socially isolated. Social isolation contributes to social frailty and physical frailty. Both frailty and social isolation can therefore be considered key outcomes for novel public health solutions.

Overall objective and specific aims

The overall objective is to develop a program theory for engaging older persons in a program that combines physical and social activities to prevent frailty and reduces social isolation, operationalize this program for adoption and implementation in the community setting, and evaluate the effectiveness and implementation in two Swiss Cantons. The ENGAGE project will achieve this through the following aims:

1. To investigate current practice regarding screening and management of older persons’ frailty risk and social isolation in primary and community care, and identify determinants for improving these outcomes in this setting.
2. To investigate experiences and perceptions of older persons concerning their participation in a community program that focusses on physical activity and social engagement, and identify determinants for their participation.
3. To develop a program theory for frailty prevention and reduction of social isolation and to operationalise this in a program that combines physical and social activities that is adopted and implemented in the community setting.
4. To implement the program in two Swiss cantons and test the acceptability and feasibility, and to evaluate its impact on reducing frailty and social isolation in older persons living in the community, and to identify determinants for and costs of implementation.

Methods

A multi-phased mixed methods project methodology will be used, in collaboration with a Patient and Public Involvement (PPI) group. First, a mixed methods study will be performed using QUAN – QUAL explanatory sequential design, including a survey and interviews with healthcare professionals and community stakeholders (Objective 1). Second, a qualitative study using semi-structured interviews with older persons will be conducted, followed by group discussions using a World Café methodology (objective 2). Third, Intervention Mapping will be used to develop a program theory for preventing frailty and reducing social isolation, and will be operationalized in a program in the community that combines physical and social activities (objective 4). Fourth, a pragmatic effectiveness–implementation hybrid type-1 trial will be conducted to evaluate the impact of the program, including its effects on frailty and social isolation. A pilot study will be embedded to evaluate study burden, acceptability and feasibility. A process -and economic evaluation are included to investigate the implementation and inform scale-up strategies and costs.

Expected results

The first program theory for frailty prevention in the community will be developed. This will be the first experimental study combining physical and social activities for frailty prevention and reduction of social isolation. This will be the first project studying implementation of frailty prevention in the community, informing scale-up.

https://nursing.unibas.ch/de/forschung/forschungsprojekte/laufende-projekte/engage/#top