Background
delirium, death, injuries, cognitive impairment
ADVERSE EVENTS, SECONDARY, EMERGENCY, COMPLICATIONS
While unnecessary ED presentations are a major issue in all hospital EDs, the risk is more so for the vulnerable RACF resident. The ED environment can be distressing and disorientating for an older person and can expose the RACF resident to unnecessary risks such as physical harm, psychological distress, and iatrogenic complications such as delirium, falls, medication errors, pressure injuries and even death [In the last decade, an extraordinary increase in people aged over 65 years has been observed in almost all countries [More and more older adults are spending a longer time living independently at home before transitioning to a RACF. This transition often occurs when individuals are in poorer health and have more complex care needs. The chronic and intricate physical and cognitive challenges faced by residents in residential aged care facilities (RACF) often involves coexisting conditions like frailty and cognitive impairment. These conditions render them more vulnerable, especially when it comes to advocating for their preferred treatment goals [RACFs face numerous challenges in managing residents with increased healthcare demands, resulting in greater workloads for staff and a lack of timely access to primary healthcare doctors and geriatric care expertise [Establishing goals of care are particularly important for older residents as they outline what a resident (or the carer) wants to achieve during an episode of care, within the context of their medical situation [The reliance on others to make decisions about their health care needs has contributed to higher RACF resident presentations to hospital emergency departments (ED), compared with their community counterparts [Other RACF outreach programs like INTERACT [A model of care that aims to improve primary care services for the older person in RACFs is the Aged Care Emergency (ACE) service. The Aged Care Emergency service provides outreach support to assist RACF nurses with decision-making and establishing clearly defined goals of care for the RACF resident, prior to a journey to ED [In its current form telephone calls to the ACE service are usually answered by Aged Care Service Emergency Team (ASET) registered nurses working in the ED who have advance practice knowledge in older person care. In consultation with the RACF nurses, ASET nurses provide support over the telephone, guided by evidence-based algorithms, to help determine whether transfer of the resident to ED is necessary [The ACE service is available 24 h a day, however it has two providers; the ED ACE service is available Monday to Friday between 8am and 4 pm (ED ACE hours) and a non-ED ACE service is provided by a separate primary health care provider for after-hours ACE calls.A limitation of the ACE service is that the calls are by telephone only. More recently the emergence of visual telehealth has been utilised in health care. A recent scoping review found that the addition of Visual Telehealth Consultations (VTC) reduced hospitalisation of RACF residents [Findings presented in this paper arise from the Partnerships in Aged Care Emergency using Interactive Telehealth (PACE-IT) study [to assess whether the augmentation of Age Care Emergency services through the addition of interactive Visual Telehealth Consultation (= Emergency Department Age Care Emergency Age Care Emergency/ Visual Telehealth Consultation VTC) for clinical decision-making, plus a structured and documented communication framework and telephone follow-up, reduced RACF resident presentations to ED compared to usual care within ED Age Care Emergency hours, 8am-4 pm Mon-Fri;to identify potential adverse events for residents who did not attend the ED, by conducting a 24-h follow-up survey and assessing RACF resident ED presentations within 48 h of a Visual Telehealth Consultation;to ascertain RACF staff perceptions of Visual Telehealth Consultation acceptability and useability within 48 h of participating in a Visual Telehealth Consultation;to assess uptake of Age Care Emergency / Visual Telehealth Consultation during ED Age Care Emergency hours.Several secondary outcomes have already been reported, encompassing staff perception of barriers and enablers to implementation and sustainability three-months post-implementation, staff acceptability and engagement at the same time-point, as well as resident and family experiences with the intervention one-month post-implementation [The presented findings adhere to the Standards for Reporting Implementation Studies (StaRI) checklist [