Queensland aged care provider PresCare has seen a 50 per cent reduction in unnecessary hospital transfers since implementing a sub-acute model of care at its Alexandra Gardens facility.
Transfers of aged care residents to hospital emergency departments are costly, stressful and often unnecessary or avoidable.
But research has shown that addressing the confidence and clinical skills of facility nursing staff, and improved access to resources, can potentially reduce unnecessary transfers to the ED, according to Sandra Thomson, PresCare’s chief clinical officer.
During 2014, PresCare implemented a government-funded pilot to develop a simple traffic light system to detect, assess, report and respond early to deteriorating residents.
“Prior to implementation of the sub-acute model of care, staff identified trends in care recipients being transported to hospital when their condition changed,” says Thomson, who is also facility manager at Alexandra Gardens.
“Analysis of hospital admission data confirmed the reasons for transfer were due to eight common and often avoidable clinical conditions: UTIs, chest pain, dyspnoea, dehydration, falls, constipation, delirium and end-of-life care.”
What was involved?
Thomson says the project team wanted a simple way to identify early to changes in a resident’s condition and respond quickly. They also wanted a skilled nursing service, a suite of tools to guide the decision making process when a resident deteriorated, and clear reporting lines for escalation.
“This involved up-skilling staff to provide more advanced clinical care and improved clinical communication, equipment to assist clinical assessment, and robust partnerships across the Rockhampton health sector,” says Thomson.
A committee was established to oversee and drive implementation, consisting of the hospital, Medicare Local, Central Queensland University (CQU), a geriatrician and another local residential aged care provider.
“The team coordinated information sessions internally with staff and then consulted with residents and families, GPs, Queensland Health officers and nursing staff, specialists and the Medicare Local to gain support,” she says.
A sub-acute toolkit was developed consisting of a suite of resources to guide the early identification and management of clinical deterioration in residents.
This included a simple traffic light system of green (continue as current) to amber (sub-acute) to red (acute), promoting early identification and management of symptoms for the eight common clinical conditions identified earlier.
The project also included a residential acute deterioration detection chart, end-of-life care pathway, a suite of clinical management guidelines for the eight conditions, the purchase of diagnostic equipment, new policies and an educational DVD.
“Workforce development and a clear clinical governance structure were crucial in enabling staff to identify early and deliver the clinical care encompassed by the model,” says Thomson.
What have the outcomes been?
Through an agreement with CQU, an analysis of PresCare’s model was carried out.
It found that during the first 12 months the number of residents transferred to hospital decreased by 50 per cent, while the number of days they were in hospital decreased by 57 per cent.
Since 2014 there have been no UTI admissions to hospital, falls for residents with dementia decreased by 14 per cent and falls with injury decreased by 40 per cent, Thomson reports.
“Nursing staff are now confidently working to their full scope of practice. The program has also made a positive impact on staff satisfaction, with post-project survey results finding increased staff satisfaction and motivation to 92 per cent,” she says.
Given the success, the model is now being expanded, with the Early Detection of Deterioration in Elderly (EDDIE) initiative being implemented in a second facility.
Thomson says the project has identified the importance of effective and committed clinical leadership, the need for clear reporting lines for escalation with simple tools to guide decision making, and the significance of close working relationships with hospital and residential in-reach services.
It also identified the importance of commitment and continual involvement from all staff; ongoing staff training; the establishment of clinical lead nurse positions for daily clinical leadership; GP engagement and support; and early and ongoing timely involvement of resident, family and clinicians.
Earlier this year, PresCare Alexandra Gardens won a Better Practice award in recognition of its sub-acute program.
The full version of this article, which features a profile of four aged care providers that have pioneered new and better ways of working, appears in the current issue of Australian Ageing Agenda magazine (Nov-Dec).