Dedicated ED care for older patients has economic benefit, study finds

The Trinity College research also suggests that adding a dedicated team to the care of the older person in the ED can improve outcomes for this cohort

Max Ryan

June 26, 2024

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  • Investing in an additional dedicated professional team to existing ED care can increase older patients’ quality of life and save an average of €6,128 per patient, according to a recently published Trinity College study.

    Crowding in emergency departments (EDs) is a growing problem in Ireland and internationally and, coupled with long waiting times, affects healthcare outcomes and patient satisfaction.

    A new study from researchers at Trinity College Dublin and University of Limerick examined the economic impact of adding a specific, appropriate, and dedicated team of professionals to the care already available for older patients. They found the potential cost savings are staggering, along with a significant increase in a patient’s quality of life.

    In 2023, researchers, led by Prof Dominic Trépel at Trinity College Dublin and Professor Rose Galvin at University of Limerick, conducted the Health Research Board funded OPTI-MEND trial, which looked at the impact of a novel service for older patients that introduced a dedicated ED team of health and social care professionals (HSCPs) to focus on timely assessment and intervention among people aged 65 years and over. The study of 353 older adults showed early assessment and intervention by the HSCP team reduced ED length of stay and the risk of hospital re-admissions, as well as improving patient satisfaction.

    Using this new service would mean that low acuity patients (e.g. patients who are less likely of more serious disease or complications) would also routinely see a senior occupational therapist, a senior physiotherapist and/or a senior medical social worker in addition to routine care in the ED.

    Primary clinical findings from the OPTI-MEND trial suggested that several older adults can be safely discharged from the ED following early assessment and intervention by a HSCP team (avoiding costly inpatient stays in hospital). This motivated the hypothesis that there may also be significant economic benefits and led to the collaboration between University of Limerick and Trinity College Dublin.

    After extensive scrutiny by the Trépel Lab (Trinity) of the trial data to determine changes in quality of life and estimating direct cost of HSCP, as well as downstream costs to the Irish Health Service, this new study demonstrates that investing in adding HSCP teams to existing usual care in ED increases a patient’s quality of life and presents, according to researchers, a potential national saving of €2.4 billion.

    These cost savings are largely driven by the timely discharge of older adults from the ED, meaning – if adopted nationally – the service would aim to get patients back in the comfort of home as soon as possible. This economic evaluation conducted alongside the HRB-funded OPTI-MEND trial provides definitive evidence that HSCP should be adopted as part of treatment as usual in Irish EDs or, put another way, not doing so results in overspending of €6,128 every time a low acuity patients visits the ED.

    The study was published in the journal PLOS ONE

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