Enhancing the Emergency Department Experience for Older Adults: Study Protocol for the Implementation of a Comfort Menu and Cart

Обзор

Introduction: The aging of the population is a global phenomenon, with projections indicating a significant increase in the proportion of individuals aged 60 years and older by 2050. This demographic shift requires adapting emergency department (ED) services to meet the specific demands of older patients, who often present with multiple comorbidities and face challenges such as sensory and cognitive difficulties. EDs, traditionally designed for acute illness and injury management, may not be adequately equipped to meet the unique needs of this vulnerable population. This can result in suboptimal patient experiences, prolonged ED stays, increased hospitalizations, and poorer outcomes. Methods: This study protocol outlines a before-and-after study to evaluate the impact of implementing a comfort menu and cart on the experience and outcomes of older patients treated in the ED. The study will be conducted in the ED of Hospital Sírio-Libanês (HSL), a tertiary private hospital in São Paulo, Brazil. Patients aged 60 and older who presented to the ED will be eligible for inclusion. Participants will be recruited in two phases: pre-intervention and post-implementation of the comfort menu and cart. Data will be collected through patient and staff interviews, chart reviews, and a 30-day follow-up interview. Patient experience, staff experience, length of hospital stays, hospital costs, ED readmissions, falls, delirium incidence, quality of life, functional status, cognitive performance, and mortality will be assessed. Ethics and dissemination: Ethical approval for this study has been granted by the Institutional Review Board of HSL. All participants, or their legal representatives for those with cognitive impairment, will provide written informed consent before any study procedures are initiated. The consent process has been designed keeping the study hypothesis blind by not revealing the outcomes that will be measured after the comfort cart intervention. The results will be shared with the academic community through peer-reviewed publications and presentations at relevant conferences to inform future clinical practice and research. Expected Results: A positive impact of implementing the comfort menu and cart in the ED is expected on patient-centered outcomes. Improvements in the experience of older patients and medical and multidisciplinary staff are anticipated, and improvements in other exploratory outcomes, such as length of hospital stay, hospital costs, readmissions, falls, delirium incidence, quality of life, functionality, and cognitive performance, will be explored.

Вмешательства

• Другое Comfort menu and cart
  The comfort menu and cart will be implemented after the pre-intervention data collection phase is completed. The menu will list the items available on the cart and will be presented to eligible patients in printed or digital format (on a tablet). The cart will be placed in an easily accessible area within the ED. Approximated retail prices have been previously reported. Comfort Cart Contents: * Hot and cold packs; * Extra blanket and pillow; * Face towel; * Gloves and hat; * Personal hygiene k

Первичные конечные точки

• Experience of older patients treated in the ED [Срок оценки: Baseline assessment during ED stay]

Вторичные конечные точки (4)

• Experience of medical and multidisciplinary staff involved in caring for older patients treated in the ED [Срок оценки: 3 months pre- and post-intervention, concurrent with patient inclusion]
• Institutional satisfaction indicators [Срок оценки: 30 days]
• Caregiver anxiety and depression [Срок оценки: Baseline assessment during ED stay]
• Caregiver burden [Срок оценки: Baseline assessment during ED stay]

Критерии участия

Критерии включения

• ED attendance at Hospital Sírio-Libanês (HSL), São Paulo, Brazil.
• Age ≥ 65 years.
• Capacity to consent and respond to the interview or the presence of a companion capable of doing so.

Критерии исключения

• Decline to participate in the study or use the comfort menu and cart.
• Absence of a companion able to consent to study participation and provide necessary information for patients with altered mental status or cognitive impairment.
• Decreased level of consciousness.
• Hemodynamic instability.
• Acute respiratory failure.
• Inability to be contacted by phone for the follow-up interview.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Нерандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Организация здравоохранения

Центры проведения

Бразилия · 1 центр

• Hospital Sírio Libanês — São Paulo

Публикации

• Ferreira SA, Bellolio F, Bower SM, Penna LF, Marion MAL, Aliberti MR, Avelino-Silva TJ, Morinaga CV, Curiati PK. Enhancing the emergency department experience for older adults: Study protocol for the implementation of a comfort menu and cart. PLoS One. 2025 Dec 4;20(12):e0332773. doi: 10.1371/journal.pone.0332773. eCollection 2025. PMID 41343524

Идентификаторы

NCT: NCT06681376 · AVAP-NG 3776

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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