Improving acute care for aged care residents

A new model of care to improve acute healthcare and reduce unnecessary trips to hospital for aged care residents is being trialled in Brisbane’s metropolitan south region.

 

A new model of care to improve acute healthcare and reduce unnecessary trips to hospital for aged care residents is being trialled in Brisbane’s metropolitan south region.

Funded for two years through a Queensland health department health innovation grant, CARE-PACT focuses on streamlining and educating the care pathway. It operates as a partnership between Princess Alexandra Hospital and three other acute care facilities, residential aged care facilities, GPs and Medicare Local in the region.

The model features a telephone triage service, an emergency mobile assessment service, both of which aim to reduce avoidable emergency department (ED) presentations, ED and inpatient resources to maximise early discharge, and a pathway direct from the aged care facility to specialist referrals or substitute community services.

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Dr Ellen Burkett

The program’s clinical lead, emergency physician Dr Ellen Burkett, said CARE-PACT aimed to improve the quality of care of aged care residents with acute healthcare needs beyond the scope of the GP and facility to manage independent of the hospital system.

“We are attempting to improve the quality of care both when they do come into hospital to receive those care needs but also when they remain in their facility and have us come out to assess them and improve their response,” Dr Burkett told AAA.

Reduced ED presentations

This program follows an aged care early intervention and management pilot at the Princess Alexandra Hospital based on the Gold Coast model of care, which resulted in significant reduction in ED trips for aged care residents, Dr Burkett said.

She called the reduction a positive side effect and said it was a key component of CARE-PACT, but that a patient would only remain in their facility when they were able to have their care needs met in a safe manner.

“We are ensuring that the people who need to come to hospital are coming but that they are seen quickly and their presentation is streamlined so that they are not spending hours on an ambulance trolley that is not set up to deal with the skin care needs of a frail older person,” she said.

CARE-PACT has trained emergency and ward staff at each of the four health facilities seven days a week. Dr Burkett said they could choose different modalities to assist different aged care homes based on geographical and other considerations.

“We have got a responsiveness to try and support each of those facilities and the GPs associated with care delivery in those facilities so that we can try and ensure that at the very least they have a single point of access in a very difficult to navigate hospital system,” she said.

In addition to telephone and mobile assessment services, and contingent on a facility’s technology capability, CARE-PACT can provide support via telehealth, video care planning, and video assessment.

Training for aged care

A key feature of the program is up-skilling aged care nursing staff and attending GPs to assist with care as well as determining the least distressing intervention for the patient or expediting emergency care.

Dr Burkett said they see each episode of care provided either in the aged care facility or within the ED inpatient setting as an opportunity to engage with aged care staff.

For example, if a procedure such as a catheter change was needed, the program could send CARE-PACT to the facility to provide training and support to the aged care facility nurse to carry out the procedure, Dr Burkett said. “We not only help that patient but we also potentially help patients down track of that patient at that facility.”

Recruitment for and rollout of CARE-PACT is underway and the program will attempt to engage all aged care facilities in the region. The trial  is due to end in March 2016.

Brisbane Metro South Health area fast facts:

  • 84 aged care facilities
  • 7,228 aged care beds
  • 9.9 per cent increase in aged care beds since 2008
  • 1.5 emergency department trips per aged care resident per year
Tags: acute-care, emergency-response,

3 thoughts on “Improving acute care for aged care residents

  1. In response to the question above, Dr Ellen Burkett said: “The Gold Coast model of care was established by Dr David Green and was the subject of a PhD by Dr Julia Crilly. The Aged Care Early Intervention & Management component of the model involved senior nursing staff with gerontic nursing expertise assessing and care-planning for residents on ED arrival (and review on the ward if admitted) to facilitate early discharge and reduce iatrogenic complications. The role also involves improved information sharing with RACFs to result in effective, safe discharge.”

  2. a great project, proven its worth over and over, yet diminished in organisation change?

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