A sub-acute care program designed to better detect and manage clinical deterioration and avoid the unnecessary hospitalisation of aged care residents has reduced hospital admissions by 50 per cent.
The program also reduced the total time spent in hospital by 65 per cent and saw a change in the clinical conditions that resulted in a hospital admission.
The program was developed by PresCare with funding from the Department of Social Services and piloted in its Alexandra Gardens facility in Rockhampton during 2014. It was designed and implemented with support from nurse practitioners, GPs, a geriatrician, the local emergency department and Central Queensland University.
Dee Jeffrey, manager for service improvement and innovation at PresCare and the project manager of the program, told the Leading Age Services Australia National Congress this week that the program provided immediate benefits.
It used a three-step ‘traffic-light’ system to detect, assess and treat the eight most common clinical conditions which saw Alexandra Gardens’ residents admitted to hospital: UTIs, dyspnoea, chest pain, dehydration, falls, constipation, end of life care and delirium.
Training on each of the conditions was provided to all staff and the facility purchased necessary equipment to aid assessment, such as vital sign monitors, bladder scanners and ECG machines. Clinical assessment guidelines and a detection index were developed and a communication tool, known as SPAR, was used to report clinical changes in residents.
“We didn’t just want a stand-alone assessment tool. We wanted to transform the way that we actually managed our residents when they deteriorated,” said Ms Jeffrey.
During the 12 month pilot, the facility treated 76 episodes that required sub-acute care. Since March this year, with the program now permanently in place, it has treated an additional 118 episodes.
During the pilot, the number of residents who were admitted to hospital halved and the total length of hospital stay within that period decreased by 65 per cent.
So far in 2015, only 13 residents have been admitted to hospital, down from 60 in 2013. Residents are typically admitted for 3.6 days, down from 7.1.
Reasons for hospital admission have also changed since the program’s implementation, with residents now most commonly admitted for far more acute conditions such as hematemesis, acute respiratory distress, fractures, intracranial haemorrhage, heart failure, mesenteric thrombus and atrial fibrillation.
Data from the National Health Performance Authority has put the cost of each admission to hospital via emergency at an average $4,900. Ms Jeffrey said that based on this, the 46 residents that Alexandra Gardens prevented from hospital admission during 2014 offered a potential hospital saving of $225,400. In 2015, a further 105 admissions have been prevented, a potential saving of $514,500.
PresCare now aims to roll out the program across its other facilities. Ms Jeffrey said the government should provide incentive funding to help implement such programs across the industry.
In practice
Sandra Thomson, chief clinical officer at Prescare and facility manager of Alexandra Gardens, said the benefits of being able to provide sub-acute care were most keenly demonstrated when Cyclone Marcia hit Rockhampton in February this year. The facility lost power for five days and with temperatures reaching 40°C, many frail residents became dehydrated. Thanks to the sub-acute care program, staff were able to identify symptoms and intervene quickly.
“Every single hospital at Rockhampton at the time was struggling at full capacity. I’m pleased to say we had no admissions and we had no loss of life,” she said.
Ms Thomson said that the program had improved residents’ quality of life and had bolstered relationships with the local hospital. Staff satisfaction within the facility had also improved.
“One of the most significant benefits is that staff are now working to their scope of practice, in particular the registered nurses. Staff are now confident to make that early call when they observe signs of deterioration,” she said.
The ability to provide sub-acute care meant clinical placements were more rewarding for nursing students and Alexandra Gardens had seen an increase in enrolments for placements and job applications from young registered nurses, Ms Thomson said.
“Recruiting young care staff to the aged care industry is challenging for a number of reasons, including that students assume it’s going to be boring or not challenging enough; that they won’t learn new things. So being able to show them the innovative work that happens in the aged care setting has been an eye opener.”
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Great work Dee and Prescare. Keen to hear more about it. Sorry I missed the LASA presentation!
Warm regards, Cherie