southcare geriatric flying squad · Number of ED presentations prevented – 378/491 (77%) Number...
Transcript of southcare geriatric flying squad · Number of ED presentations prevented – 378/491 (77%) Number...
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A/PROF PETER GONSKI DR SHIKHA JAIN MS ANGE PATRAS
southcare geriatric flying squad
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Aged Care Principle:
Community
Hospital Aged Care
Facilities
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Southcare (Division of Aged and Extended Care)
“One Stop Shop in Aged Care”
Hospital services MAU(ACAU)/Acute Orthogeriatrics Behaviour unit Rehabilitation
Community Services • ACAT • ASET • Transitional Care(STACS) • Community Nurses • Chronic Care (SHALT) • Rehab(o/T,physio) • Aged Care Information & Liaison
Service • Continence • Geriatrician Outpatients • Dementia Monitoring • Dementia Respite • Dementia Education/Resources
(associated with Alzheimer’s Assn)
• Frail Aged Respite • Caring Centres Co-ordination • Community Options/COMPACKS • Mobility Group • Positive Living Courses • Aged care facility Consultations • Podiatry • Transport • Community Pharmacy • Dietetics • Hydrotherapy • Equipment Lending Pool • Geriatric flying squad/NPACT • Garrawarra medical services
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Geriatic flying squad background
• 10% Australian population > 70 years
• 8.6% > 70 years live in RACF
• 30%> 85 years live in RACF
• 17-26% RACF residents hospitalised/year
• Hospital complications-delirium/falls/infections/medications
• End stage disease not well recognised
• Mortality of hospitalised RACF admissions:
40%-1 year 80% -2 years
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Staffing
Geriatrician
0800-1600
Mon-Fri
Nurse practitioner
1230-2100
Mon- Fri
Southcare community nurses
All days
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Factors affecting hospitalisation from RACF
Quick
Laboratory
access
Intravenous therapy
Rapid
Physician availability
Geriatric Flying Squad
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What we do
Any resident from aged care facility with acute deterioration in whom
hospital transfer is been considered
Review by Geriatrician/Nurse Practitioner within 2-4 hours
GP consents to service
Excludes
Life threatening illness/surgical problem for active treatment
Ongoing chronic issues
GP not consenting
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Pathways of care
Treatment in the facility with close follow up
Direct admission to ACAU bed for investigations and management
Referral to ED
1
2
3
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Service goals
• Improve quality of care by minimizing disruptions in care and iatrogenic complications in hospital
• Improve palliative care services in RACFs
• Reduce avoidable hospital admissions
• Off Load Emergency by facilitating direct admissions
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01/11/2011-30/06/2013
Number of ED presentations prevented – 378/491 (77%)
Number of hospitalization prevented- 348/491 (70%)
Total referrals 502
Intervention
491
Hospitalized
57
Direct ward bed
30
Admission via ED
27
Managed in RACF
434
Acute care
348
Quality care
86
No intervention
11
Emergency transfer
4
Cancelled by LMO
4
Not appropriate
3
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Referral trend
0
10
20
30
40
50
60
70
No
v-1
1
Dec
-11
Jan
-12
Feb
Mar
ch
Ap
ril
May
Jun
e
July
Au
gust
Sep
tem
ber
Oct
ob
er
No
v-1
2
Dec
-12
Jan
-13
Fe b
13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
No of referrals
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Referral reason No of patients
Delirium 72
Chest Infection/Aspiration 65
Abdominal symptoms 65
End of life/symptomatic care 64
Cellulitis/Other skin infections 59
BPSD 33
CCF/chest pain/tachycardia/syncope 29
Sepsis of unknown origin/General Rv 39
Pain control 24
Acute musculoskeletal /mobility issues 18
Acute stroke/headache 8
PEG tube replacement 7
High INR 5
SPC reinsertion 2
Anaemia/DVT 3
Diabetic foot gangrene 2
Acute Ischemic leg 2
Withdrawal from alcohol 1
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Equipment used for the service
• Car
• Medication
• IV drug kits
• IV fluid bags
• Syringe drivers
• Bladder scanner
• Portable ECG machine
• Portable audio venous and arterial doppler
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Benefits • Comfort • Patient/family/carer/aged care facility/GP satisfaction • Transport reduction(ambulance) • bed usage reduction(ED and general ward)
• Cost:$188,000/year • Efficiency:$437,400
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Challenges
• Getting referrals from RACFs
• Ability for RACF to continue care
• After hours
• Workforce-reliant on expertise and staff numbers
• (GP buy-in)
• Relationships:GPs/RACFs/ED/wards/private hospitals/community services-nursing,continence,stoma,palliative care