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Fast track acute assessment for older persons

What it is

A dedicated hospital ward that is staffed and equipped to receive non-critical older people with complex needs. The model provides specialist assessment, care and treatment of the older person for up to a designated period (usually between 48-72 hours) prior to transfer to a ward or home if appropriate. The aim of the model is to improve the processes and clinical care of older people with acute needs and to facilitate the progression and early discharge from the acute care setting back into more appropriate community-based care.

How it works

Patients can be transferred into this ward from the Emergency Department (ED) or from external sources such as primary care practitioners or programs, for example known General Practitioners, GRACE, VACS and the geriatric flying squad can all make direct admissions to this ward for further assessment. The short turnaround allows for older people to undergo extensive medical and multidisciplinary assessment from experienced staff in order to initiate immediate and appropriate care planning, treatment and investigations in a timely manner.Most patients that are admitted to the model are expecting to be discharged home with community assistance as needed. A minority will require transfer to an acute or subacute ward.

Consultation revealed that cardiac telemetry monitoring can improve the provision of services and patient flow because it allows a larger cohort of patients to be admitted to the ward - that is those presenting with a cardiac issue or comorbidity. As this is highly prevalent in this cohort, and is often undiagnosed, parallel monitoring of telemetry on this ward allows for an efficient use of time and holistic care approach.

Purpose-built or closed/secure assessment units also offer the benefit of being able to manage delirium or disturbed behaviour better, without the use of pharmacological or physical restraints.

Resourcing

The model is staffed by a multidisciplinary team comprising of geriatricians and senior nursing staff such as the Nurse Unit Manager, Nurse Practitioner or Clinical Nurse Consultant, as well as increased input from Allied Health team members. Priority access to diagnostics services is a key feature of the model.

Success factors

  • Extended assessment period to resolve often complex issues (e.g. OPERA)
  • Multidisciplinary team, including for example, a social worker, occupational therapist and/or physiotherapist
  • A geriatrician that is able to establish an early care plan
  • Collaboration with ED and patient flow managers to facilitate the transfer of patients between ED and the model
  • A process to facilitate transfer from primary care to the model.

Models in operation

  • OPERA
  • ACAU
  • MAU/OPERA