Telephone assessment of acutely ill and injured older adults

Aim

The purpose of this research project is to study how the out-of-hours medical service handles telephone calls from older adults, and what happens after the contact. We will also investigate whether training healthcare professionals working at the out-of-hours medical service and some additional questions over the telephone can improve how older adults are assessed and managed.

Background

When people get acutely ill or injured, the first contact with health care services in Norway is often a telephone call to the out-of-hours medical services (legevakt). The telephone operator assesses the condition of the patient and decides what action to take. Older adults can be particularly challenging to assess over the telephone.

The presentation and tolerance of acute illness/injury in this patient group very much rely on the patient’s health status and functional level before he/she got acutely ill/injured. If the operator does not have information about this, the risk of misinterpreting the presented symptoms and consequently misinterpreting the urgency degree, is large. As of today, the patient’s premorbid health status and functional level is not systematically assessed when older adults call the out-of-hours medical services.

A rapid way to assess a person’s health status and functional level, can be to screen for frailty. Frailty is a medical term encompassing a vulnerability for acute episodes, and older adults with frailty often have other symptoms and signs of illness and injury than robust older adults and younger adults. Frailty is associated with poor outcome following acute illness and injury. Therefore, frailty screening tools have been incorporated in the assessment of older adults in various healthcare services – to aid risk assessment, interpretation of signs and symptoms and choosing appropriate management for the patient. However, screening tools suitable to detect frailty during telephone calls to the out-of-hours medical services are lacking.

What does the project entail?

We have developed a screening tool consisting of three questions about health status and functional level before the acute illness/injury occurred. In this project we are going to test if this tool can be used to detect frailty among older adults who call the out-of-hours medical services.

The tool will be tested through an intervention study with three phases. Various qualities of the tool will be investigated: feasibility, validity and effect. We will collect data from patients before (phase 1) and after (phase 2) the tool is implemented. When the data collection from patients is finished, operators that have participated in testing the tool will answer an electronic survey about their experience with the tool (phase 3).

Four different out-of-hours medical services participate in the project.

Patient data is collected through telephone interviews. During the project period, patients 70 years and older who call the participating out-of-hours medical services are registered. After the call, patients who fulfil the inclusion criteria receive an invitation to participate by post. If the patient consent to participate, he/she is contacted by the research group by telephone approximately 30 days after the contact with the out-of-hours medical service. He/she is asked to provide information about his/her health and use of healthcare services in the period following the telephone contact.

The information collected is stored in Services for Sensitive Data (Tjenester for Sensitive Data).

Value

The project will provide valuable new knowledge about acutely ill and injured older adults that call the out-of-hour medical services. This patient group is fast growing and there is little research into how these patients best can be managed.

We hypothesise that a screening tool for frailty can be a useful supplement to the traditional ways to assess the urgency degree on incoming calls to the out-of-hours medical services. It will allow operators to make a more informed decision on what action should be taken in each case.

Screening tools for frailty have not previously been tested in the acute or emergency medical call setting, thus the study will provide sought-after knowledge on whether such tools are feasible to use in this setting.