Aged Care Emergency

Hunter New England Excellence Awards Winner: Building Partnerships 2014

Background

The Aged Care Emergency (ACE) Model of Care (MOC) is a Nurse led integrated MOC that consolidates the successful outcomes of the implementation of the ACE project piloted at John Hunter Hospital in 2010/11 and 2011/12. The success of this pilot led to further funding of 10 Emergency Departments (EDs) in NSW in 2012/13 by the Ministry of Health and NSW Emergency Care Institute. Funding was provided for implementation of the ACE model with local evaluation of the impact on the ED and quality of care for patients living in Residential Aged Care Facilities (RACFs) that may need to come to ED. The final reports from the 10 participating EDs can be found below.

Older people require emergency care more often than other populations. They have longer ED length of stay and higher admission and readmission rates. Older people account for greater than 60% of hospital admissions and are at risk from hospitalisation itself, particularly delirium. Older people who become acutely unwell in RACFs are a considerable proportion of ED presentations. A number of studies have found that for certain disorders or comorbidities; effective treatment does not necessitate presentation to ED from the RACF. For example, those with acute infections treated in their residence have similar or better survival and fewer complications compared to those transferred to hospital for treatment, even accounting for severity.

The ACE MOC was developed in response to the identified need for EDs to better manage the demand placed upon them by the health and care needs of older people and, when older people present to the ED, to provide safe, quality care of older people within the ED.

A gap exists in emergency care support to residents in RACF to facilitate acute care within the facility rather than transportation to hospital EDs. The ACE program has demonstrated improved emergency care for people living in RACFs through dedicated services in the form of telephone support, guidance, direction and collaboration led by an experienced Acute Aged Care Nurse. The pilot of this program at John Hunter Hospital has demonstrated transfers and subsequent admissions for people living in the RACFs has reduced including a 35% reduction in occupied bed days and 16% reduction in ED presentations. Clear goals of care are a key feature for transfer along with improved clinical handover focusing on the need for the acute hospital to deliver clinical care that aligns with the predetermined needs.

Deliverable outcomes:

  • reduced ED presentation for patients from RACFs
  • reduced hospital admissions for patients from RACFs
  • reduced occupied bed days for patients from RACFs
  • improved NEAT performance through avoidance of ED presentations, avoiding admissions and more focussed quality of care in the ED
  • commitment to Excellence program through better communication systems in the ED, hospital and RACFs
  • enhanced integration of a range of services for older people in order to reduce ED presentations eg Hospital in the Home (HITH), Connecting Care, General Practitioners and Medical Local Groups

For further information and queries please contact Sarah Hoy on sahoy@doh.health.nsw.gov.au or (02) 9391 9410.

Resources

Final Reports from Sites

© Agency for Clinical Innovation 2017

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