Life In The Slower Lane

Here is the structured PICO analysis for the fourteenth article you uploaded:

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Full Title (verbatim and exact):

“Does telehealth influence the decision to transfer residents of residential aged care facilities to emergency departments? A scoping review”

Sunner C, Giles MT, Kable A, Foureur M

International Journal of Older People Nursing (2023); 18:e12517

DOI: https://doi.org/10.1111/opn.12517

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Type of Article:

Scoping review (PRISMA-ScR compliant)

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PICO Analysis:

Population:

• Residents of residential aged care facilities (RACFs) aged 65 years or older
• Broad inclusion of settings described as RACFs, nursing homes, long-term care homes, skilled nursing facilities, or assisted living facilities
• Studies reviewed included those from the USA, Hong Kong, Australia, Canada, France, Germany, Singapore, UK, and Italy

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Intervention:

• Use of telehealth (including video/real-time visual assessments and consultations)
• Applications included:
  • Emergency care triage
  • Geriatric, psychiatric, dental, wound, and palliative consultations
  • Medication review
  • Oral health and podiatry assessments
• Used by GPs, geriatricians, nurses, pharmacists, social workers, and specialists across various care domains

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Comparator:

• Usual care (e.g. in-person assessments, no telehealth access, standard decision-making regarding ED transfers)
• In some studies, comparator groups were RACFs not engaged in telehealth, or pre-telehealth implementation phases

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Outcome:

1. Person-centred outcomes:

• Reduced ED transfers in most studies:
  • Joseph et al. (2020): 27% of telehealth group transferred to ED vs. 71% control (OR = 0.15; p < .001)
  • Hofmeyer et al. (2016): 69% of telehealth consults managed in RACF
  • Residents expressed less distress, improved comfort, greater inclusion in decision-making, and positive experiences with telehealth 

2. Process outcomes:

• Improved assessment skills and decision-making confidence among RACF nurses
• Support for timely access to multidisciplinary input and care escalation when required
• Some studies noted better integration of primary and specialist care, more rapid triage, and enhanced inter-professional collaboration 

3. Health system outcomes:

• Hospital avoidance consistently reported across studies (though not all were statistically significant)
• Cost savings from reduced ambulance transfers, fewer admissions, and lower length of stay:
  • Estimated savings up to US$1.6 million in some contexts
  • Up to 39% return on investment in one UK study
• Barriers included: staff workload, telehealth underutilisation, technical limitations for physical exams, poor GP engagement, and difficulties embedding services 

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Summary Conclusion:

This scoping review synthesises broad international evidence supporting the use of telehealth in RACFs to improve decision-making and potentially reduce emergency department transfers. Although variable in quality, many studies report that telehealth facilitates clinical support, enhances nurse assessment confidence, is well accepted by residents, and can yield cost savings. The review identifies a strong case for embedding telehealth into aged care policy and clinical practice, while also highlighting the need for robust trial data, better GP integration, and strategies to address staffing and technological barriers.

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