CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

摘要: Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss independence, death. Effective interventions reduce remain poorly implemented due their complexity, require an organised approach change care practices systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced length stay in pilot studies one hospital. This study will test effectiveness implementing using multi-site cluster randomised trial inform transferability this intervention. A hybrid design evaluate the implementation strategy real-world setting. multisite be conducted 8 medical surgical wards 4 hospitals, ward each site implement (intervention) continue usual (control). Intervention supported develop locally tailored strategies enhance early mobility, nutrition, meaningful activities. Resources include trained, mentored facilitator, audit support, trained healthcare assistant, support by expert facilitator team i-PARIHS framework. Patient outcomes process measures before after compared between control wards. Primary any syndrome (delirium, falls, injuries, new incontinence) stay. Secondary discharge destination; 30-day mortality, function quality life; 6 month readmissions; cost-effectiveness. Process patient interviews, activity mapping mealtime audits measure improvement progress. Factors influencing trajectory success monitored on Using guided explicit framework, CHERISH establish effectiveness, cost-effectiveness successful program for improving older inpatients, identify features that implementation. ACTRN12615000879561 registered prospectively 21/8/2015.