The economic impact of changing the way health care is delivered to older adults in emergency departments

Emergency department (ED) crowding is a growing problem in Ireland and internationally, and combined with long waiting times, this is impacting healthcare outcomes and patient satisfaction. A new study from researchers at Trinity College Dublin and the University of Limerick has examined the economic impact of adding a specific, appropriate and dedicated team of professionals to the care already available to older patients. The researchers found that the potential cost savings are enormous, along with a significant increase in a patient’s quality of life.

The study is published in PLoS ONE.

In 2023, researchers led by Professor Dominic Trépel from Trinity College Dublin and Professor Rose Galvin from the University of Limerick conducted the OPTI-MEND study, which looked at the impact of a new service for older patients requiring a dedicated emergency care team introduced. and social care professionals (HSCPs) to focus on timely assessment and intervention in people aged 65 and over. The study of 353 older adults found that early assessment and intervention by the HSCP team reduced emergency department length of stay and risk of hospital readmissions, and improved patient satisfaction.

Using this new service would mean that patients with low visual acuity (e.g. patients who are less likely to develop more serious illness or complications) would also routinely see a senior occupational therapist, a senior physiotherapist and/or a senior medical social worker would visit. care in the emergency department.

Primary clinical findings from the OPTI-MEND study suggested that several older adults were safely discharged from the emergency department after early assessment and intervention by an HSCP team (avoiding expensive hospital stays). This motivated the hypothesis that there may also be significant economic benefits and led to the collaboration between the University of Limerick and Trinity College Dublin.

Following extensive examination by the Trépel Lab (Trinity) of the trial data to identify changes in quality of life and estimate the direct costs of HSCP, as well as the downstream costs to the Irish healthcare system, this new research shows that investing in adding HSCP teams Adding to the existing normal care in the emergency department increases a patient’s quality of life and, according to researchers, results in a potential national saving of € 2.4 billion.

These cost savings are largely driven by the timely discharge of older adults from emergency departments, meaning that if rolled out nationally, the service would be aimed at getting patients back to the comfort of home as quickly as possible. This economic evaluation, carried out alongside the OPTI-MEND study, provides definitive evidence that HSCP should be applied as part of treatment as usual in Irish emergency departments, or put differently, failure to do so will result in an overspend of € 6,128 every time a patient with low acuity sensitivity visits. the ED.

Commenting on the findings, Professor Dominic Trépel, School of Medicine and Global Brain Health Institute (GBHI), Trinity, said: “Clinical trials have historically aimed to generate evidence to support doctors’ decisions. However, the OPTI-MEND study is an excellent example of the power of including an economic perspective and a testament to the Health Research Board’s commitment to ensuring that the studies they fund include the perspectives of patients and the public and consider how our money is spent.

“As our healthcare system has to manage a limited budget, studies like this show that small investments in HSCP teams in Ireland’s 27 emergency departments can free up up to €2.4 billion for other services, while at the same time improving health-related quality of care can be significantly improved. To live.”

Professor Rose Galvin, School of Allied Health, University of Limerick, added: “We expected there would be economic benefits but are shocked by the amount of money that can be made available by simply deploying HSCP teams and at the same time significantly improve the health of older ER patients. Given what we have learned about the power of incorporating economics into our clinical research, Prof. Trépel and I are now working together to investigate the value of home-based comprehensive geriatric assessments, just like OPTI-MEND, we hope that this new research program that will further demonstrate the clinical and cost-effectiveness of improvements to our service landscape and will help shape Irish healthcare for generations to come.”