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Outreach service reduces resident hospital admissions

An on-call medical service for 24 aged care facilities in Brisbane has prevented more than 600 unnecessary trips to the emergency department and up to 500 unnecessary hospitalisations over a 12-month period, an internal evaluation shows.

The trial involved 24 residential aged care facilities in north Brisbane and access to the on-call Geriatric Outreach Assessment Service (GOAS) at the Prince Charles Hospital to assist with the acute care needs of residents.

As previously reported, the service, which is jointly funded by Brisbane North Primary Health Network and Metro North Hospital and Health Service, was implemented in June last year to improve the quality of medical care of residents through person-centred, proactive and timely care (read more here).

During the 12-month trial, GOAS provided care to 744 residents and delivered 960 episodes of care.

Of those, 638 episodes were considered to be potentially prevented emergency department presentations (66 per cent) and of these, 498 were potentially prevented hospitalisations (78 per cent), the internal evaluation shows.

Michele Smith

Brisbane North PHN executive manager for aged and community care Michele Smith said GOAS was effective in saving costs for the health system.

“Our analysis showed that without GOAS, it would have cost the Queensland Government anywhere from $3.5 million to $4.5 million to provide hospital treatment for the 744 aged care residents involved in the 12-month trial,” Ms Smith said.

She said the pilot cost $746,000 inclusive of set up expenses.

“We expect GOAS will cost just $464,000 a year to run on an ongoing basis,” Ms Smith said.

The trial also found the average length of stay for residents from facilities participating in the trial (1.68 days) was less than residents from non-participating facilities (2.3 days).

“Our evaluation confirms GOAS provides responsive, high quality and person-centred medical care at the right time and in the right place,” Ms Smith said.

Other key elements of the GOAS include identification and risk stratification, comprehensive geriatric assessment, coordination and continuity of care, and capacity, relationship and partnership building.

Throughout the pilot, GOAS provided 417 training sessions on 22 clinical pathways to 3,019 aged care staff as part of efforts to build clinical capacity.

The evaluation found that 84 per cent of participants found the education and training useful.

A similar scheme, the Geriatric Rapid Acute Care Evaluation (GRACE) program, launched in the ACT in October last year to improve aged care resident healthcare and unnecessary presentations at Calvary Public Hospital’s emergency department. This model differs to GOAS as it is driven by Calvary’s emergency department.

The GOAS evaluation recommended a population health approach to the funding and provision of care of older people in all community and hospital settings to improve coordination and integration across the patient journey.

GOAS will continue to be offered as part of Metro North’s Residential Aged Care Assessment and Referral Service (RADAR), however staff will no longer receive training.

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