title: 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.
abstract: 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 of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention.
  
  
  
  A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards.
  
  
  
  Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation.
  
  
  
  ACTRN12615000879561 registered prospectively 21/8/2015.
authors.affiliation: Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. Alison.Mudge@health.qld.gov.au.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Mudge
authors.affiliation: Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
authors.forename: Merrilyn D
authors.initials: MD
authors.lastname: Banks
authors.affiliation: Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.affiliation: John Richards Initiative, Australian Institute of Primary Care and Ageing, La Trobe University, Albury-Wodonga, Australia.
authors.forename: Irene
authors.initials: I
authors.lastname: Blackberry
authors.affiliation: Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Australia.
authors.forename: Theresa
authors.initials: T
authors.lastname: Green
authors.affiliation: University of Adelaide, Adelaide, Australia.
authors.forename: Gillian
authors.initials: G
authors.lastname: Harvey
authors.affiliation: Centre for Research in Geriatric Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Hubbard
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Centre, Institute for Aging Research, Hebrew Senior Life, Boston, USA.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Cognitive Decline Partnership Centre, Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kurrle
authors.affiliation: Melbourne Medical School, University of Melbourne, Melbourne, Australia.
authors.forename: Kwang
authors.initials: K
authors.lastname: Lim
authors.affiliation: Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
authors.forename: Prue
authors.initials: P
authors.lastname: McRae
authors.affiliation: Centre for Research in Geriatric Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Nancye M
authors.initials: NM
authors.lastname: Peel
authors.affiliation: Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Suna
authors.affiliation: Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Young
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis / Q000379:methods; D003693:Delirium / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D005247:Feeding Behavior / Q000502:physiology / Q000523:psychology*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D009752:Nutritional Status / Q000502:physiology; D010351:Patient Discharge / Q000639:trends; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D012107:Research Design; D013577:Syndrome; D016138:Walking / Q000502:physiology / Q000523:psychology*
keywords: Acute care; Aged; Delirium; Elderly; Facilitation; Falls; Functional decline; Hospital care organisation; Hospitalisation; Implementation; Implementation framework; Incontinence; Pressure injuries; Pressure ulcer; Urinary incontinence