Life In The Slower Lane

Here is the structured PICO analysis for the thirty-second article you uploaded:

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Full Title (verbatim and exact):

“PACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities”

Sunner C, Giles MT, Parker V, et al.

BMC Health Services Research (2020); 20:672

DOI: https://doi.org/10.1186/s12913-020-05539-1

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Type of Article:

Study protocol for a stepped-wedge cluster randomised controlled trial

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PICO Analysis:

Population:

• Residents of 16 residential aged-care facilities (RACFs) in New South Wales, Australia, associated with four emergency departments (EDs) across two Local Health Districts
• Total cohort covers ~1435 beds, with high rates of emergency transfers (>40 per 100 beds/year)
• Participants are older adults living in RACFs who experience an acute health concern and may otherwise be transferred to ED 

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Intervention:

PACE-IT model – an augmentation of the existing Aged Care Emergency (ACE) model, incorporating:

1. Visual Telehealth Consultation (VTC) between the RACF and ED-based ACE nurse (via video)
2. Protocol-guided decision-making and ISBAR handover
3. Automated summary sent to GP and RACF
4. 24-hour follow-up call to monitor outcomes if resident was not transferred
5. Outcome recorded in ED patient management system (PMS)

This model replaces the standard telephone-only consultation with a more interactive, visual assessment process.

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Comparator:

• Usual care, defined as the pre-existing telephone-based ACE outreach model, involving verbal handover and shared decision-making without video assessment 

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Outcome:

1. Person-centred outcomes:

• Resident and family experience of VTC: assessed through interviews about participation, decision-making, and satisfaction
• RACF staff experience: evaluated via surveys after each VTC and focus groups at 3 months post-intervention
• Qualitative themes include perceptions of accessibility, communication, usefulness, and emotional comfort during care decisions 

2. Process outcomes:

• Primary outcome:
  • Reduction in ED presentations per 100 RACF beds per year
  • Hypothesis: 30% reduction in ED transfers due to VTC use
• Secondary outcomes:
  • ED attendance within 48h post-VTC (adverse events)
  • Implementation acceptability and engagement
  • Cost-consequence analysis
  • Staff compliance and technical quality of VTC 

3. Health system outcomes:

• Cost avoidance via reduced ED presentations and ambulance use
• Potential statewide scalability across 68,967 RACF residents, with estimated avoidance of 15,000 hospital presentations per year
• Budget impact analysis and downstream health service implications included 

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Summary Conclusion:

The PACE-IT study evaluates whether adding visual telehealth consultations (VTC) to an existing nurse-led RACF-ED outreach model reduces emergency transfers from residential aged care. The trial uses a stepped-wedge cluster design across 16 RACFs and is paired with comprehensive process, cost, and qualitative evaluations. If effective, this model may offer scalable improvements in care coordination, reduce unnecessary hospitalisations, and enhance resident and family involvement in care decisions. The intervention leverages existing ACE infrastructure and adds video support, shared decision-making, and structured follow-up.

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