The OPERATE Research Program (Older Persons Early Recognition, Access and Treatment in Emergencies) (Phase 1)

The initial part of OPERATE Phase I is an environmental scan of existing interventions specifically designed to decrease pressure on emergency departments from acute presentations by older persons (aged 65 and older). This exploratory process will identify such interventions across the three adult tertiary health services emergency departments in Perth, Western Australia. The interventions will be screened and selected for appropriate scope matching the goals of the project; quality and granularity of any clinical or evaluation data; engagement with the research project; and the resources required to perform the evaluation. The screening and selection process will be undertaken by the investigator team which consists of 25 persons and includes emergency physicians, geriatricians, allied health professionals, nurses, consumers, academic clinicians and health system scientists. Once consensus is reached of the participating interventions, data from individual patients having had an intervention will be identified and accessed from pre-existing evaluation data and pre-existing routinely collected clinical and systems information in the respective health services. These data will be merged and analysed to describe the clinical service outcomes for each patient such as ED attendance and hospital admission. Since these data are retrospectively obtained and routinely collected, human research ethics approvals will be sought for waiver of consent for obtaining patient clinical data. No prospective data will be collected. The dates and duration of the data collected will be individualised for each intervention in terms of commencement of service, and numbers of patients undergoing the intervention. It is expected that the duration of data collection for each invention will be six to twelve months and the individual patient data captured will form the exposure cohort, It is expected the data collection will occur within the period of 2020 to 2024 but the exact dates of data collection will vary according to each intervention. Once the detailed evaluation is completed by the investigator team, a blueprinting process will occur to prioritise the interventions in terms of the ability to be integrated into a coordinated process (across pre-, in- and post-emergency department interventions) and potential for safely and effectively decreasing the pressure on emergency departments. The blueprinting process will involve the investigator team using a Delphi approach. This will require coordination from a steering group, several iterative rounds of surveys, anonymity of members submissions, controlled feedback, a priori excluding/closing criteria for each round, and stability and consensus of results. The results of the blueprinting will form the basis for implementation of a proof-of-concept model of acute aged care.