Aim
To improve quality of care and reduce emergency department presentations and hospital admissions for residential aged care facility residents within a framework of patient safety and choice.
Benefits
- reduce ED presentations
- reduce hospital admissions
- reduction in iatrogenic complications
- reduce LOS of ED and inpatient admissions
- increased patient and carer satisfaction
Background
The increasing percentage of older people, and those requiring residential aged care, is placing unprecedented pressure on the Hospital and Health Service. Primary care funding has not increased appreciably for over 20 years and our most at risk older people are struggling more than ever to have consistent primary care support. This is even more evident in the unplanned care of the older person.
Given reported rates of presentation of RACF patients of 0.1 to 1.5 ED transfers per RACF resident bed per year, with admission rates of 40 to 60 per cent, the increasing number of RACF residents have resulted in demand pressures on both ED and inpatient beds. Patients and their families consistently express a desire to receive acute treatment in their home environments; however, existing acute care substitution models fail to leverage the unique, accredited professional environment of RACFs. In addition, there is a failure to address the complex array of factors that influence the transfer of RACF patients to hospital, including RACF staff skill mix and resources, perceived risk and patient functional and cognitive impairment.
A restricted pilot of the CARE-PACT model demonstrated a 31.17 per cent absolute reduction in ED presentations of RACF patients aged 65+ years; 31.15 per cent absolute reduction in acute admissions via ED; and 26 per cent or 1.7 days reduction in inpatient length of stay of RACF patients.
MSHHS applied to and received funding from the Health Innovation Fund which was created to support innovative ideas which support service delivery and patient care with the potential for statewide application.
