Introduction
A 2017 retrospective study of three Australian hospitals reported an observed incidence rate of non-beneficial treatment among end-of-life admissions of 12% (range 6% to 19%). Mean duration of non-beneficial treatment was 15 days, with one third of those days spent in the Intensive Care Unit (ICU), at an estimated annual national health system cost of $A153 million (1).
Aims / Hypothesis
The InterACT study will implement a prospective feedback loop intervention to increase appropriate care for older patients at the end-of-life. It is hypothesised that providing objective information to clinicians about the risk profile of their patients will prompt a review of care and reduce the incidence of non-beneficial treatments.
Methods
A stepped-wedge cluster randomised trial will be implemented in three large acute Queensland hospitals from February 2020 to June 2021, with five clinical teams enrolled per hospital. Patients aged 75 years or older admitted under the clinical teams will be prospectively screened using two validated tools to identify those at high risk of mortality and deterioration, and this information provided regularly to the treating clinical teams.
Outcomes
The primary outcome is the proportion of patients with one or more ICU admissions. Other outcomes assess length of hospital stay and discharge outcome, time to hospital re-admission, time to first documented clinician-led care review, time to care directive measures and palliative care referral, and medical emergency calls use. Health care resource use, costs and the implementation process will also be evaluated.
Implications for practice
The feedback loop will raise clinician awareness and provide a stimulus for clinical teams to review patient pathways and choose alternatives including palliative care. This will improve services at the end of life, free up hospital bed days, and improve outcomes for patients and families.
Conclusion
The InterACT study partnership will generate new evidence and embed connections with clinicians and health services to inform policy and initiatives in reducing non-beneficial treatment at the end of life.
Funding acknowledgement
This project is funded by a National Health and Medical Research Council (NHMRC) partnership project grant (GNT1151923) and led by Queensland University of Technology.