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Emergency Department assessment / bypass specific to older persons 

What it is

A dedicated area in the ED that is quarantined to provide early specialist assessment of an older person and to provide a care plan early in an older person’s hospital journey.

How it works

The older person is either transferred directly from triage after assessment by the triage nurse, or pulled from the acute/subacute areas in ED by the model’s staff (doctor or nurse). The model targets patients aged 65-70 years and older or those with age-related symptoms. 

Aged health specialists assess the older person, and create a care plan to be implemented on transfer to the ward (Medical Assessment Unit, acute aged health ward) or as part of their discharge home. The aim is for an aged health specialist to establish a care plan as soon as possible in the journey in order to decrease the amount of time a patient spends in hospital. Older people that are discharged are referred to their General Practitioner or community services as appropriate although the linkage here is sometimes absent.

Resourcing

The model is staffed by aged health specialists such as geriatricians, aged health registrars, aged health Clinical Nurse Consultants (CNCs) and Registered Nurses. The model is located in the ED with access to diagnostic services such as x-ray, pathology and Aged Care Service Emergency Teams (ASET) services. 

Success factors

  • Due to the complexity of the older patient, it is essential to utilise senior decision-makers that specialise in aged care such as geriatricians, aged health registrars and senior CNCs. CNCs show success in establishing a diagnosis and care plan early, rather than risking deterioration in the older patient by management by a junior staff member).
  • Educating ED staff on which people that are eligible for and should be referred to the model. 

Models in operation

  • HOPE ED (Westmead)
  • ED MAU (Nepean)