The QAS Falls Co-Response Program

Aim

• Undertake a comprehensive, on scene, multidisciplinary assessment of the person within their environment, to inform disposition planning, including consideration of the need for transportation to hospital;
• Provide multidisciplinary treatment / interventions for patients based on their individual needs;
• Provide timely care coordination to support patients to remain safe in the community (where appropriate) after they have had a fall, through internal Queensland Health Hospital and Health Service pathways and connection to existing non-government organisation involved in the patients care;
• Further development and utilisation of appropriate referral pathways supported by the Hospital and Health Service and broader health sector stakeholders;
• Strengthen and streamline existing referral pathways which already exist between the QAS and the Hospital and Health Services for timely and integrated care in the community; and
• Utilise the skills of both paramedics and Allied Health Practitioners to provide a holistic assessment and rapid care response

Outcomes

Having a documented model of care and roles and responsibilities from commencement of the service was invaluable for the team to refer to as required. A model of care will also enable the scaling up of the service from its two existing sites.

The crews work autonomously and there is the potential to feel isolated from ‘the team’. Strategies trialled and implemented to overcome this included:

• an orientation to the QAS Falls Co-Response Program which was jointly provided to both paramedics and allied health practitioners. This face-to-face program enabled members of this new service to meet each other and start to build collegial relationships
• peer shifts have been embedded to ensure consistency in service provision between allied health clinicians
• discipline specific supervision within Community and Oral Health Directorates for allied health practitioners
• social events.

Background

People who experience a fall requiring assistance are the most common call for service to the QAS.

Falls related incidents represented 8.7% of all incidents attended by QAS paramedics following a Triple Zero (000) call in the 2020 and 2021 calendar years. Falls disproportionally affect those in the older adult population (aged 65 years and older). Across Metro North and Metro South Health Regions, this cohort represents approximately 67% of the people who fall requiring the assistance of the QAS. With the Australian Bureau of Statistics projecting a 70% increase in older adults residing in Classified as OFFICIAL the Metro North and Metro South catchments by 2036, demand for falls related incidents is expected to also increase [1].

Methods

Two units are operating in the Brisbane metropolitan region (Metro North and Metro South HHSs), each comprising a two-member crew of a paramedic and allied health practitioner (occupational therapist or physiotherapist). These units provide an accelerated ‘see, treat and intervene’ service for falls incidents received via Triple Zero (000) to the QAS.

This initiative facilitates greater integration between the existing Metro North and Metro South Health post fall follow-up and referral pathways, by providing on scene presence of an appropriately qualified allied health professional who can undertake a comprehensive assessment of the patient in their home environment to inform falls assessment and management plans in a timely manner.
Patients assessed by the QAS Falls Co-Response Program are transported to a hospital Emergency Department (ED) significantly less frequently than those seen by standard acute paramedic crews (49% vs 77%), and response time is quicker (41 minutes vs 58 minutes)

With the expansion of the secondary triaging scope of work completed by the Clinical Hub, the QAS Falls Co-Response Program is one of many referral pathways. To compliment the Clinical Hub process, it has been integral for paramedics to have access to information technology systems which enable them to identify and self-attach to cases to ensure optimal use of time within the service.

Discussion

The QAS Falls Co-Response model of care has evolved through the project implementation to ensure the service is able to meet the needs of the community and the QAS. In the first four months of service (16 October 2023 – 4 February 2024), the crews responded to 647 incidents. The average age of patients seen by the crews is 75 years. 53% (n=333) of the incidents have been within Metro North Health catchment, however the Metro South based crew has seen more patients (n=343) overall (noting crews cross Health Service boundaries as required).

To evaluate the effect of the initial roll-out of the QAS Falls Co-Response Program, data on falls incidents attended by the QAS Falls Co-Response crews has been compared with data from previous years (2020 and 2021) for falls of a similar nature for which there was a standard acute response in the same areas where QAS Falls Co-Response Program now operates. Typically, falls incidents are categorised by an Emergency Medical Dispatcher responding to a Triple Zero (000) call as requiring an immediate response, no lights and sirens within the QAS dispatching system. The QAS Falls CoResponse crews take on average 41 minutes from the Triple Zero (000) call being received to arriving on scene, compared with 58 minutes in the comparison group.

Consumer involvement is key to ensuring the QAS Falls Co-Response Program meets consumer needs. We are conducting surveys and interviews with consumers and/or carers/family members to better understand consumer experience, perceptions and satisfaction with the service and the outcomes, and specifically to determine identify areas for improvement. Survey participation is online, or via phone if preferred by the consumer.

Partnering across the health system has enabled timely access and pathways of care for patients who call Triple Zero (000) following a fall. Through comprehensive multidisciplinary assessment and access to follow-up pathways, the patient experience has been improved and demand on hospital services reduced.

Lessons learnt

Consistency of staff in the initial implementation phase is critical to success. While the allied health team is small and consistent, initial variability in the paramedic roster did create some challenge while processes were still being identified and embedded.