Eat Walk Engage

Aim

EAT WALK ENGAGE^™ aims to improve care for older people in hospital, prevent delirium and promote faster recovery. EAT WALK ENGAGE^™ supports hospitals to be older-person friendly through engaging older consumers and carers, improving team communication, empowering local leadership, supporting education and training, and advocating for environmental redesign.

Outcomes

EAT WALK ENGAGE^™has demonstrated the following benefits in trials and roll-out:

• reduction in hospital acquired delirium by 47%
• improved patient flow due to
  • decreased length of stay
  • increased discharge home and less rehabilitation needs
• improved team communication with older patients
• improved person-centred care practices
• improved age-friendly enabling environments
• positive staff and patient experience

The program is aligned with ACSQHC Standard 2 (Partnering with Consumers) and Standard 5 (Comprehensive Care).

Background

Hospitals are caring for greater numbers of older people, who account for half of hospital inpatient bed days. Older and more frail people are at increased risk of hospital-associated harm, most commonly delirium (affecting 20-25% of older inpatients) and functional decline (affecting 30-35%). These complications cause distress for patients and carers, higher nursing needs, and poor longer term outcomes including death, disability and dementia. It is imperative that hospitals adopt evidence to prevent and care for these common complications.

Strong consistent evidence shows that early regular mobility, adequate nutrition and hydration and meaningful cognitive and social activities can reduce delirium and functional decline if delivered as integrated, multidisciplinary programs. Sadly, evidence also shows that these ‘basic’ cares are often missed in busy acute care settings, especially in older patients whose care needs are higher due to frailty or cognitive impairment, due to a complex range of patient, ward and organisational barriers.

EAT WALK ENGAGE^™ was developed at the Royal Brisbane and Women’s Hospital where the program is implemented in eight acute medical, surgical and oncology wards. The program has been implemented in a phased roll-out across Queensland public hospitals since 2019, and as at early 2023 is in 41 wards across 17 hospitals.

Discussion

EAT WALK ENGAGE^™ was implemented in eight acute medical, surgical and oncology wards at the RBWH. The program has been implemented in a phased roll-out across Queensland public hospitals since 2019, and as at early 2023 is in 41 wards across 17 hospitals.

Published evaluation provides a rigorous evidence base (see references):

• Pilot evaluation on a medical ward showed decreased length of stay and improved mobility and engagement with no increase in falls.
• Pre-post evaluation on a vascular surgical ward showed improved mobility, a trend to reduced delirium and functional decline, and reduced length of stay and discharge to continuing care.
• Cluster randomised CHERISH trial in medical and surgical wards in four Queensland hospitals showed 47% reduction in delirium, increased discharge home, and trend to reduced six-month mortality and readmission.
• Cost-effectiveness modelling at Flinders University using data from the CHERISH trial showed likely saving of more than 800 acute bed days and 50 subacute admissions per year in medical wards (unpublished data).
• Annual reporting of process measures for the state-wide rollout shows improved team communication, better mealtime care, and improved mobility and engagement.

Lessons learnt

• Successful roll-out of EAT WALK ENGAGE^™ has been supported by a state-wide program leadership team taking a phased approach, building learning communities, and ensuring reliable process measurement and benchmarking. Lessons learnt include:
  • Facilitation is a unique role and skill set that requires intensive training and mentoring.
  • Staff turnover and skill mix and leadership changes are challenges for sustainment.
  • Building and maintaining relationships with consumers, clinical leads and other key stakeholders is critical to maintaining program success.
  • Sharing success through workshops and communities of practice helps solve problems and maintain energy, especially through challenging times.
  • Monitoring patient experience and process indicators is crucial for informing continuing improvements.

References

Mudge A, McRae P, Cruickshank M. Eat Walk Engage: An interdisciplinary collaborative model to improve care of hospitalized elders. Am J Med Qual 2015; 30 (1): 5-13

Cahill M, Lee-Steere K, Mudge A, McRae P. Eat Walk Engage: a delirium prevention program for acute care. Aust J Dementia Care 2018; 7 (3)

Mudge AM, McRae P, Banks M, Blackberry I, Barrimore S, Endacott J, Graves N, Green T, Harvey G, Hubbard R, Kurrle S, Lee-Steere K, Lim WK, Masel P, Pandy S, Young A, Barnett A, Inouye SK. Effect of a ward-based program on hospital-associated complications and length of stay for older inpatients: the cluster randomized CHERISH trial. JAMA Internal Med 2022; 182 (3): 274-282

Lee-Steere K, Liddle J, Mudge A, Bennett S, McRae P, Barrimore S. “You’ve got to keep moving, keep going”: Understanding older patients’ experiences and perceptions of delirium and non-pharmacological delirium prevention strategies in the acute hospital setting. J Clin Nurs 2020; 29 (13-14): 2363-2377

Mudge A, McRae P, Donovan P, Reade M. A multidisciplinary quality improvement program for older patients admitted to a vascular surgery ward. Internal Medicine Journal 2020; 50 (6):741-48

Cahill M, Neill S, Treleaven E, Lee-Steere K, Carter A, McCormack L, Mudge A. Eat Walk Engage: enabling acute care teams to deliver consistent fundamentals of care for older people. J Adv Nurs 2022 online early

Further Reading

Hospital Elder Life Program

Australian Delirium Clinical Care Standard

ACSQHC caring for patients with cognitive impairment

Johns Hopkins Activity and Mobility Promotion program

Improving nutrition and mealtime care