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Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit.

Harwood RH, Goldberg SE, Whittamore KH, Russell C, Gladman JR, Jones RG, Porock D, Lewis SA, Bradshaw LE, Elliot RA, Medical Crises in Older People Study Group (MCO - Trials (2011)

Bottom Line: We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care.Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham NG7 1RD, UK. rowan.harwood@nuh.nhs.uk

ABSTRACT

Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.

Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.

Trial registration number: ClinicalTrials.gov: NCT01136148.

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Related in: MedlinePlus

Randomisation and bed management algorithm. Patients with codes <4000 are randomised with stratification according to care home residence or not, and are approached for trial inclusion. Patients with codes >4000 are not randomly allocated, and are not eligible for trial inclusion.
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Figure 1: Randomisation and bed management algorithm. Patients with codes <4000 are randomised with stratification according to care home residence or not, and are approached for trial inclusion. Patients with codes >4000 are not randomly allocated, and are not eligible for trial inclusion.

Mentions: Potentially suitable patients are referred to MMHU by clinical staff on the Acute Medical Admissions Units, within 24 hours of admission. MMHU staff record details on a computerised screening log. An algorithm allocates patients either to MMHU or a standard care ward, some at random, others not (Figure 1). If allocated to MMHU the patient is transferred immediately. If allocated standard care, an alternative bed is found by Admissions Unit staff.


Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit.

Harwood RH, Goldberg SE, Whittamore KH, Russell C, Gladman JR, Jones RG, Porock D, Lewis SA, Bradshaw LE, Elliot RA, Medical Crises in Older People Study Group (MCO - Trials (2011)

Randomisation and bed management algorithm. Patients with codes <4000 are randomised with stratification according to care home residence or not, and are approached for trial inclusion. Patients with codes >4000 are not randomly allocated, and are not eligible for trial inclusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117715&req=5

Figure 1: Randomisation and bed management algorithm. Patients with codes <4000 are randomised with stratification according to care home residence or not, and are approached for trial inclusion. Patients with codes >4000 are not randomly allocated, and are not eligible for trial inclusion.
Mentions: Potentially suitable patients are referred to MMHU by clinical staff on the Acute Medical Admissions Units, within 24 hours of admission. MMHU staff record details on a computerised screening log. An algorithm allocates patients either to MMHU or a standard care ward, some at random, others not (Figure 1). If allocated to MMHU the patient is transferred immediately. If allocated standard care, an alternative bed is found by Admissions Unit staff.

Bottom Line: We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care.Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham NG7 1RD, UK. rowan.harwood@nuh.nhs.uk

ABSTRACT

Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective.

Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.

Trial registration number: ClinicalTrials.gov: NCT01136148.

Show MeSH
Related in: MedlinePlus