Geriatric Transitional Care for Older Patients Discharged From the Emergency Department: Impact on Early Readmissions

Recruiting now · Not applicable

Conditions studied: Hospital Readmissions of Elderly Patients

In brief

Elderly adults have high rates of emergency department (ED) visits. Specificities of this population challenge organizations of care in the ED, and older adults are at risk of pejorative outcomes after an ED stay. Numerous interventions have been designed to improve quality of care and outcomes for the older population in these settings, with a specific attention to concerning discharge from the ED. These interventions are interdisciplinary, bridging emergency and geriatric care. The wide range and complexity of these interventions make them difficult to assess and compare, as highlighted by several reviews in the past ten years. Prior analyses helped to categorize different intervention strategies and three main designs: inhospital, community and transitional interventions started in the ED and pursued in collaboration with community primary care professionals . Theses analyses show that the use of multiple strategies and transitional models of care tend to lead to better outcomes, and underline that more robust studies are needed to confirm this hypothesis. In France a majority of EDs collaborate with Geriatric Mobile Teams (GMT) to improve quality of care for older patients. GMTs are dedicated to patients over 75 years old, and interventions in EDs are targeted on patients at risk of worse outcome. When ED physicians detect older patients at risk they may call for the GMT for further assessment and management. GMTs either work in a inhospital standard approach or with a transitional care management. This second strategy, less common in France, is thought to be be efficient and has never been assessed. We have designed a study to compare these methods, with the hypothesis that among at-risk older adults, hospital-community transition care initiated by GMTs during an ED visit with direct discharge home will be associated with a reduction in the risk of early readmission within 30 days, and lower risk of loss of independence at 3 and 6 months. It is a french multicentric study, with a quasi-experimental design, comparing hospitals without transitional care management to hospitals with hospital-community transitional intervention. We aim at enrolling 1322 patients aged 75 and more at risk of pejorative outcomes as determined by the Triage Risk Screening Toll (TRST). The main outcome is a revisit to the ED between day 7 and day 30, secondary outcomes are autonomy, mortality, use of hospital services and caregiving at home at 6 months.

Key facts

Study ID: NCT05814328
Run by: Assistance Publique - Hôpitaux de Paris
People needed: 1322
Starts: 2025-03-04
Expected to finish: 2027-02-01
Last updated by the study team: 2025-05-16

Who can join

Age: 75 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Patient admitted to the emergency departement over 75 years old and living at home (including independent residence)
Patient admitted to the Emergency Reception Service (ERS) for less than 48 hours for whom a return home has been decided
Identified at risk of readmissions to the emergency departement with a Triage Risk Screening Tool (TRST) score > 2.
Consent to the study possible at the time of his visit to the emergency room by the patient or a caregiver present at the time of inclusion.
Patient affiliated with a social security (beneficiary or partner)

You may not qualify if…

Person living in an nursing home
Severe cognitive impairment according to DSM V criteria and absence of a close relative at the time of inclusion
Unstabilized psychiatric pathology and absence of relatives at the time of inclusion
Language barrier and absence of relatives at the time of inclusion
Person under guardianship, under legal safeguard measure, deprived of liberty by judicial or administrative decision, persons subject to psychiatric care without their consent, persons admitted to a health or social establishment for purposes other than those of the research
Patient under state medical assistance
Patient already included in the research

Where it is running

Bichat Hospital — Paris, France (enrolling)

Full record on ClinicalTrials.gov

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