Reducing hospital associated complications in older people: Results from the CHERISH cluster randomised controlled study

Mrs Prue McRae1, Dr Merrilyn  Banks1,2, Dr Adrienne  Young1,2, Professor Ruth Hubbard3, Dr  Nancye Peel3, Professor Adrian Barnett2, Associate Professor Kwang Lim4,5, Professor Nicholas  Graves2, Professor  Susan  Kurrle6, Professor Irene Blackberry4,7, Professor  Theresa  Green2, Professor  Sharon Inouye8,9, Assoc Prof Alison  Mudge1,2

1Royal Brisbane And Women’s Hospital, Brisbane, Australia, 2QUT, Brisbane, Australia, 3University of Queensland, Brisbane, Australia, 4University of Melbourne, Melbourne, Australia, 5Royal Melbourne Hospital, Melbourne, Australia, 6University of Sydney, Sydney, Australia, 7La Trobe University, Wodonga, Australia, 8Harvard Medical School, Boston, United States of America, 9Aging Brain Center, Boston, United States of America

Background: Hospital-associated complications of older people (HAC-OP) include delirium, functional decline, incontinence, falls and pressure injuries. These are associated with longer hospital stays and new admission to aged care facilities.  This study aimed to implement “Eat Walk Engage” to reduce HAC-OP and length of stay in acute care older patients. Eat Walk Engage is a multi-component program facilitating multidisciplinary practice changes to improve mobility, nutrition care and cognitive engagement.

Methods: We used a pragmatic cluster randomized trial design to evaluate Eat Walk Engage. We enrolled inpatients aged 65 years or older, admitted for 3 days or more to eight acute medical and surgical wards in four Queensland public hospitals. Primary outcomes were length of stay and any new HAC-OP. Secondary outcomes included individual new HAC-OP and discharge home.  Analyses were adjusted for age, sex, co-morbidities, admission functional and cognitive status, elective status and hospital.

Results: Implementation commenced on the four intervention wards in January 2016. Between October 2016-March 2017 we enrolled 539 participants (265 intervention, 274 control) of whom 305 (57%) were aged 75 years or older, 269 (50%) were female. Median length of stay was 6 days in intervention (IQR 4 to 9 days) vs 7 days in control (IQR 5 to 10 days), adjusted hazard ratio 0.96 (95% CI 0.80-1.15). HAC-OP occurred in 115/248 (46%) intervention vs 129/249 (52%) control, adjusted OR 1.07 (0.71-1.61). Delirium was significantly reduced, occurring in 37 (14%) of intervention vs 69 (25%) control participants, adjusted OR 0.58 (0.36-0.94). In the intervention group, 199/259 (77%) participants were discharged home compared with 180/271 (66%) control, adjusted OR 1.46 (95% CI 0.94-2.25).

Conclusions: Eat Walk Engage showed a significant reduction in delirium and  may have improved direct discharge home, although length of stay and other HAC-OP were not significantly reduced.


Prue Mcrae is the Eat Walk Engage Program Manager at the Royal Brisbane and Women’s Hospital

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