Research Abstract: Free Paper - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Aims: Transitional care strategies (TCS) initiated for elderly patients prior to emergency department (ED) discharge are important to ensure effective transition to other care settings. It has been shown to reduce avoidable acute admissions. This first nationwide study is targeted at public acute hospital EDs in Singapore, and aims to: (1) characterise TCS for ED-discharged elderly patients and (2) understand the experiences of healthcare staff in TCS delivery.

Methods: An exploratory mixed-methods study design was used. Seven key informants (KI) (one per ED) completed an online structured questionnaire and semi-structured video-conference interview between 8 May to 31 August 2021. The KI was an ED specialist or ED-trained senior staff nurse, knowledgeable in geriatric emergency care and contributed to at least one elder-related TCS. Field notes were compiled, transcribed, anonymised and analysed using thematic analysis.

Results: All seven EDs have TCS as “usual care” available during office hours, at no extra cost to patients (Table 1). Common components include screening, evaluation with Comprehensive Geriatric Assessment, health education and follow-up telecare. Three main themes were identified to be facilitators of TCS implementation: organisational support, collaboration of a competent multidisciplinary care team, and involvement of family and caregivers. Obstacles faced include: fragmented communication between personnel, limited resources, poor buy-in from stakeholders.

Conclusion: Understanding the heterogeneity of ED-TCS will aid development of service typology and identify service opportunities, such as addressing social determinants of health contributing to recidivism. Provider experiences gathered will help to inform future strategies for TCS implementation. More research is needed to evaluate patient outcomes and cost-effectiveness of TCS.