More than 90 per cent of aged care residents destined for the emergency department were successfully treated in their facility with support from a dedicated local health service, study shows.
The lead researcher into the Southcare Geriatric Flying Squad (GFS), whose findings were published in Internal Medicine Journal this month, said she was impressed by the “rapid uptake” of the new model by local facilities.
The GFS, which began in November 2011, is a rapid response outreach service from the Sutherland Hospital and Community Health Service servicing the Sydney South metropolitan area.
Its team of a geriatrician, nurse practitioner and clinical nurse consultant provide a comprehensive assessment within two to four hours of referral to improve acute and palliative care in aged care facilities while reducing resident transfers to hospital.
The study, led by Southcare GFS staff specialist geriatrician Shikha Jain, reviewed the outcomes of the seven-day service between 1 April 2015 and 30 September 2016.
It found that of the 640 residents seen by the GFS, 578 were successfully managed at the facility (90 per cent), 35 were transferred to the emergency department (6 per cent) and 27 were directly admitted to a medical ward (4 per cent).
Without GFS involvement, all of these residents would have been transferred to the emergency department, Dr Jain said.
“The most impressive finding was our ability to manage more than 90 per cent of acutely unwell patients within the aged care facility in a timely and efficient manner,” Dr Jain told Australian Ageing Agenda.
“We were also impressed by the rapid uptake of this new model of care by the local facilities. This was in spite of their increased workload when looking after acutely unwell patients within their facility as opposed to sending them to hospital.”
The five most common reasons for referral were respiratory symptoms, delirium, sepsis, dehydration and acute symptom management, according to the research.
The success of this type of service model relied on collaboration with facilities and involved improving skills, competency and confidence of the nurses working within the aged care facility, Dr Jain said.
“Facilities have been able to provide much better care at end of life for their residents instead of sending them to hospital. There is also a significant increase in advance care-planning documentation for newly admitted residents, which could improve further with education and support to facilities.”
Terminal palliative care was provided to 116 of the residents in the study (18 per cent), and all 26 residential aged care facilities in the catchment area used the GFS during the study period.
Dr Jain attributed the universal take up to multiple education services provided to all the facilities along with a simplified referral process that would make it easier for facilities to call the GFS than complete paperwork for sending residents to hospital. She said:
“We specifically targeted facilities who were frequently sending their residents to hospital for conditions that can be managed safely in an out of hospital setting with support from services such as GFS. These facilities were provided more education and support and were encouraged to call us first before calling an ambulance.”
The service, which costs around $400,000 per year to run, is more cost-effective than hospital-related costs if residents are sent to emergency or are admitted, Dr Jain said.
The model, which has drawn national and international interest from other health networks since winning a NSW Health innovation award in 2013, can be successfully replicated, she said.
Geriatric flying squads have been set up at the Prince of Wales and War Memorial hospitals in Sydney’s eastern suburbs.
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