The economic impact of changing how health care is delivered to older people in emergency departments

Emergency department (ED) crowding, which is becoming a global issue in Ireland, is detrimental to patient satisfaction and the quality of medical care when combined with lengthy wait times. The financial effects of supplementing the current care for elderly patients with a particular, researchers from Trinity College Dublin and the University of Limerick have examined a suitable and dedicated team of specialists. The study’s findings indicate that patients could see a considerable improvement in their quality of life in addition to enormous potential financial savings.

The OPTI-MEND trial was carried out in 2023 by researchers under the direction of Professors Dominic Trépel of Trinity College Dublin and Rose Galvin of the University of Limerick. The trial examined the effects of a novel service for older patients, which introduced an ED team of health and social care professionals (HSCPs) with a focus on timely assessment and intervention among individuals 65 years of age and older. According to the 353 older persons in the study, patient satisfaction increased and ED length of stay as well as the likelihood of hospital re-admissions were decreased with early assessment and intervention by the HSCP team.

Employing this new service would entail routinely seeing a senior physiotherapist, senior occupational therapist, senior medical social worker, and/or senior occupational therapist in addition to standard ED care for low-acuity patients, or those who are less likely to have more serious disease or consequences.

The OPTI-MEND trial’s primary clinical findings indicated that a number of older persons might be safely released from the emergency department (ED) after an HSCP team assessed them and took appropriate action, thereby avoiding expensive hospital stays. The University of Limerick and Trinity College Dublin collaborated as a result of this, which supported the theory that there might potentially be major economic advantages.

This new study shows that adding HSCP teams to existing normal care in the ED improves patient quality of life and presents a potential national savings of €2.4 billion, according to researchers, after extensive scrutiny by the Trépel Lab (Trinity) of the trial data to determine changes in quality of life and estimate the direct cost of HSCP as well as after-tax expenses for the Irish Health System.

If the service were to be implemented nationally, it would strive to bring patients back in the comfort of their own homes as quickly as possible, as the timely release of older persons from the ED is a major factor in these cost reductions. In other words, there would be overspending of €6,128 each time a low-acuity patient visits the ED if HSCP is not implemented as standard treatment in Irish EDs, as demonstrated by this economic evaluation carried out in conjunction with the OPTI-MEND experiment.

Professor Dominic Trépel of Trinity’s School of Medicine and Global Brain Health Institute (GBHI) commented on the results, saying, “Historically, the goal of clinical trials has been to produce information that supports physician decision-making. But the OPTI-MEND study is a great illustration of the value of taking an economic viewpoint into account, and it’s proof of the Health Research Board’s determination to make sure studies they support take into account public and patient perspectives as well as how our money is spent.

Studies like this one, which show that a minor investment in HSCP teams throughout Ireland’s 27 Emergency Departments might liberate up to €2.4 billion for other services while also considerably increasing health-related quality of life, show how our health system must manage a limited budget. Prof. Rose Galvin of the University of Limerick’s School of Allied Health stated, We expected there would be economic benefits, but have been shocked at how much money can be made available by simply deploying HSCP teams while significantly improving the health of older ED patients.

Professor Trépel and I are now working together to investigate the usefulness of home-based comprehensive geriatric assessments in light of what we have discovered about the effectiveness of including economics into our clinical study. Similar to OPTI-MEND, we anticipate that this new research program will help define Irish health care for future generations by demonstrating the clinical and financial efficacy of enhancements to our service landscape.

For further details, see Dominic Trépel et al. When compared to standard therapy, the early evaluation and intervention by a committed team of health and social care professionals for elderly patients in the emergency room is more cost-effective.

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