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Emergency assessment at residence 

What it is

A hospital outreach service that delivers care to Residential Aged Care Facilities (RACFs) or to the home to reduce the need for people to be transferred to hospital. This decreases hospital presentations/admissions and increases the comfort of the older person and carer by allowing them to remain in their familiar home environment. This decreases older person, carer and family stress and anxiety about being transferred and admitted to hospital.

How it works

The model is usually requested for older people that are non-critical but acute enough to warrant a same-day review, rather than having them wait days for a General Practice (GP) assessment and risk the patient deteriorating, or alternatively, calling an ambulance or sending the older person to the Emergency Department (ED).

The method for receiving care from the model is as follows: RACFs, GPs or persons known to the service will contact the service regarding a person’s deteriorating health needs (this is usually only undertaken after the person’s GP has been notified and provides consent). The team will then attend the RACF or home and provide assessment and treatment of the person. This can include Hospital in the Home type activities such as diagnoses (pathology) and intravenous medication/therapy. 

Consultations found that this model has significantly reduced the number of transfers to the ED from RACF. The operating hours are during business hours, Monday to Friday. After-hours care is available but dependent on the facility.

Resourcing

Staff consists of either a geriatrician and/or nurse practitioner (NP). After-hours consultations are usually performed by the NP. One site noted the use of a mobile x-ray service in their area as a significant benefit in preventing the transfer of many older people after a fall or suspected fracture.

Success factors

  • A senior aged care decision-maker such as a geriatrician as a point of clinical guidance or follow-up of complex cases
  • Skilled liaison with strong communication and clinical skills – which builds trust
  • Fast response to requests, e.g. the model is deployed within two hours of request 
  • Strong relationship with Residential Aged Care Facilities including through educating them on the model
  • Strong communication links with General Practitioners to provide an understanding of the services and provide an update of the model’s management
  • Ability for nurse practitioner to order diagnostics and prescribe – which is not always the case.

Models in operation

  • VACS (Nepean)
  • Geriatric Flying Squad (Sutherland)
  • GREAT (Westmead)
  • GRACE (Hornsby)
  • Aged and Chronic Care Triage (Concord)