Better healthcare for acutely unwell aged care residents

A local trial has found that geriatrician-led medical outreach to residential aged care facilities (RACFs) improves quality of patient care and dramatically reduces preventable Emergency Department presentations and hospitalisations.

The Geriatric Outreach Assessment Service (GOAS) model-of-care was trialled over 12 months at 24 RACFs within The Prince Charles Hospital (TPCH) catchment.

Brisbane North PHN contributed Australian Government funding to cover approximately two thirds of trial funding, with Metro North Hospital and Health Service (HHS) providing the balance.

The project team included a part-time Geriatrician, a full-time Registrar, two Clinical Nurses and an administration officer, with support from an External Service Facilitator, Clinical Nurse Consultant.

Evaluation results, announced on August 29 at Mercy Community Aged Care Services in Nudgee, show the GOAS treated 744 acutely unwell RACF residents and potentially prevented 638 Emergency Department presentations.

Over the life of the pilot project, the team provided 960 episodes of care (an average of four episodes per day) in total.

The average length of stay for residents of in-scope RACFs who were hospitalised was 1.68 days, compared to 2.3 days for out-of-scope RACFs, a reduction of 0.62 days.

Michele Smith, Brisbane North PHN’s Executive Manager for Aged and Community Care, said the GOAS model-of-care could save the State Government up to $4 million a year.

“Our analysis showed that without GOAS, it would have cost the Queensland Government anywhere from $3.5m to $4.3m to treat the residents involved in this trial,” Ms Smith said.

“By comparison, our pilot project cost $746K, inclusive of set up expenses, and we expect GOAS will cost just $464K per year to run on an ongoing basis,” she said.

There was also overwhelming support for GOAS among the aged care residents and staff involved.

Results from more than 1,700 survey responses showed GOAS had improved quality of care for RACF residents, with 98 per cent of consumers likely to recommend the service to others.

“Our evaluation confirms GOAS provides responsive, high quality and person-centred medical care at the right time and in the right place,” Ms Smith said.

The evaluation has recommended an expansion of GOAS across all hospitals in Brisbane North to ensure a regionally-consistent approach to the provision of healthcare to unwell RACF residents.

Cross-sector collaboration, across aged care, primary and secondary care, was key to the successful design, planning and implementation of the GOAS.

Metro North HHS Executive Director of Clinical Services Dr Elizabeth Whiting said engagement at the interface between acute and aged care had been critical to project success.

“While more time is needed to assess the long-term effects of GOAS on acute care, surveys show a vast majority of aged care workers are now more confident in managing an acutely unwell resident,” Dr Whiting said.

The GOAS team provided 417 training sessions on 22 clinical pathways to upskill the 3,019 aged care staff involved in the project.

“Going forward, we will continue to offer GOAS as part of Metro North’s Residential Aged Care Assessment and Referral (RADAR) Service,” Dr Whiting said.

The RADAR Service is available between 8.00am-4.00pm weekdays (phone 1300 072 327).

Among other findings from the GOAS evaluation:

  • 24 in-scope RACFs within the TPCH catchment showed a declining trend in inpatient hospital admissions compared to out-of-scope RACFs
  • Emergency Department presentations by residents of in-scope RACFs remained stable, despite an increase in available RACF beds within the catchment area
  • 71 per cent of GOAS episodes of care were same-day services and 91 per cent of episodes were seen by both a Registrar and a Clinical Nurse.

The GOAS evaluation has recommended taking a population health approach to the funding and provision of care of older people in all community and hospital settings to improve coordination and integration across the whole patient journey.

This is consistent with the key directions identified in the jointly agreed Five Year Health Care Plan For Older People Who Live In Brisbane North (2017-2022), available here http://bit.ly/2NlSDjW.

To download a summary report on the GOAS evaluation or to access the full 126-page report, go to http://bit.ly/2Nl2cQc.