The Acute Geriatric Evaluation Service (AGES)

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Initiative Type
Model of Care
Status
Deliver
Added
29 January 2018
Last updated
07 January 2023

Summary

The service provides a fluid model of assessment, acute care, education, support and continuity of care to residents and staff of aged care facilities (RACF) as well as their General Practitioners (GPs). Ultimately AGES works to provide outstanding care and support to empower patients, their families and healthcare teams.

The project was a finalist at the 2017 Queensland Health Awards for Excellence.

Key dates
Nov 2016
Dec 2017
Implementation sites
Toowoomba Hospital

Aim

To transcend previous boundaries which limited the integration of patient care across acute and community sectors.

Benefits

  • Acute response service for RACF residents to enable clinical assessment and provide acute interventions within their nursing home rather than having to attend the emergency department.
  • All residents of RACFs who require medical admission to hospital are admitted under the AGES team to ensure continuity of care.
  • Timely communication with GPs and nursing home staff to ensure continuity of care for residents following discharge.
  • Post discharge follow up and clinical support for residents (if required), RACF staff and GPs to enhance patient outcomes.
  • Community review of RACF residents via telehealth with the AGES geriatrician to provide ongoing specialist advice and support to all members of the healthcare team.
  • Education opportunities to RACF staff to support clinical up skilling and timely recognition of a resident requiring medical review.

Background

Barriers existed between community and acute sectors. This highlighted an opportunity to develop a new model of care for RACF patients to receive the right care, in the right place at the right time.

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Key contact

Karen Gordon
Service Manager and Nursing Director
Darling Downs Hospital and Health Service
(07) 4616 6179
Karen.gordon@health.qld.gov.au

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