Older adults (≥65 years) are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. The six-item Identification of Seniors At Risk (ISAR) screening tool identifies older adults at high risk of early adverse outcomes following emergency department (ED) visit including ED return, functional decline, unplanned hospitalisation, or death. The ISAR has demonstrated high predictive ability in a recent systematic review of 32 international validation studies. Following screening with the ISAR, it is recommended that older adults who score ≥2 points are referred to a specialist geriatric team for Standardised Evaluation and Intervention for Seniors at Risk (SEISAR). While several studies validated the ISAR as a screening instrument, there is a lack of studies evaluating the impact of the ISAR/SEISAR approach on patient and process outcomes in the ED. This study explores whether implementing the two-step comprehensive approach to screening using ISAR, and assessment and intervention using SEISAR, among 640 older adults who present to the ED and are subsequently discharged, reduces 30 day adverse outcomes including ED return, emergency hospitalisation, functional decline and falls. A qualitative methodology will be employed with staff across four clinical sites (ED, Acute Medical Assessment Unit, and Local Injury Units) to explore barriers and facilitators the implementation of the ISAR/SEISAR. We will implement change strategies to facilitate uptake based on the output from these interviews. This mixed-methods impact analysis study will employ the International Diagnostic and Prognostic Prediction Group (IDAPP) framework for impact analysis and implementation of clinical prediction rules. We hypothesise that routine screening with ISAR and targeted assessment and intervention with SEISAR will reduce 30 day adverse outcomes in this cohort. Furthermore, the ISAR will also assist the clinical decision making process to determine which “low risk” older adults can be safely discharged from the ED.
