“One of my grandmothers lived at home until 104 years of age. She was an inspiration to all of us. As an Emergency Physician, we strive to do our best for all people, but I have a soft spot for older adults.”
Dr Tanya Mellett, Staff Specialist at Townsville University Hospital, shares her passion for improving emergency care for older adults, a vulnerable patient cohort.
Supported by a Trauma Care grant, Dr Mellett set off on a research mission to improve care for older adults with head injuries in the ED.
When older adults present to the ED with head injuries, it is routine to investigate these injuries using cCT to rule out ciTBI, despite there being a low incidence of this type of injury. However, this study found that older patients with minor head injuries do not always require a head scan, and some patients can be safely diagnosed and managed with less intensive options.
The team enrolled 276 patients in the study, and the results highlighted the need to reassess routine head scans for older people. 81% of the patient cohort had a cCT during their initial ED visit, yet only 2.5% of patients were found to have ciTBI.
“This was the first of its kind prospective, observational study done in Australia. Our ED staff enthusiastically recruited 7 days a week including overnight in addition to our EMF funded research nurse. The results have highlighted the importance of person-centred acute care. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially amongst those from residential aged care facilities,” Dr Mellett summarised.
A person-centred approach as suggested would significantly improve patient care for older adults who have the right to high quality care in the setting that best meets their needs and wishes. A reliance on scanning results in longer wait times and higher levels of distress, especially for those in rural and remote areas who do not have immediate access to diagnostic methods, leading to time-consuming and costly transfers to other hospitals.
The team’s ambitions are to continue this line of research to inform changes in policy and practice in treating older adults in the ED. Dr Mellett shares her plan for future research endeavours.
“Townsville University Hospital and The Princess Alexandra Hospital in Brisbane are in the early development phase of a multi-site prospective study that we may call INSIGHT-ED: INformed choice Study of Imaging Geriatric Head Trauma in Emergency Departments. It will look into the safety, effectiveness, and cost-effectiveness of a shared decision-making approach in diagnostic stewardship of cranial Computed Tomography in older patients with ground-level falls.”