Strengths and limitations
PMS
Different methods of data collection were utilised for this study to ensure rigour. Primary outcome data measuring RACF ED presentations and VTCs were collected monthly from PMS and included information on demographic characteristics of RACF residents, presenting problem and call outcome (ED presentation or alternative care pathway). The generalisability of this study was ensured by engaging with different locations and contexts, and by selecting EDs for their metropolitan and rural locations.At any given time, the randomised mixture of sites ensured that some sites had the intervention, and some did not, thus accounting for secular variations. The fixed effect for step will control for a common underlying secular trend across all clusters [The study was unlikely to have achieved the planned statistical power, due to the lower overall rate of ED presentations because of the impact of the COVID pandemic and subsequent lockdowns, as well as a slightly lower than anticipated intervention effect. However, the overall reduction in ED presentations per 100 RACF beds of 29%, while not statistically significant, demonstrates an important clinical effect.