Published on March 10, 2014
Geriatric Flying Squads A new age in geriatric community management
Flying Squads • flying squad • n. Chiefly British • A small mobile unit, especially of motorized police, capable of moving quickly into action, as during an emergency.
Medical Flying Squads • An Obstetric Flying Squad is a form of medical retrieval team that is composed of an obstetrician, anaesthetist, midwife and other healthcare personnel who are on-call to attend to mothers with major obstetric complications occurring in the community. • Accident and Emergency Flying Squads
Geriatric Flying Squads • A need for fast response geriatric community care was identified • Community dwelling elders were presenting to emergency rooms because the wait for community care was up to 6 months • Over 50% ED presentations from RACF were unnecessary and could have been managed in the facilities with appropriate care
War Memorial Hospital • Community based specialist geriatric hospital – ‘one stop shop for the elderly’ • Physio, Hydro, OT, Social Work, Speech Pathology, Continence, clinical psychology, Diet, Falls and Parkinson's clinics, inpatient rehabilitation • Based in the outpatient dept • Use of all of the WMH resources
War Memorial’s GFS • • • • Started in May 2010 COAG funding Nurse led/coordinated Multi-disciplinary team including a geriatrician • Comprehensive Geriatric Assessment • Short term case management • Community dwelling and low level RACF
War Memorial’s GFS • • • • 9-5pm, 5 days a week Sub acute program Flexibility of service Direct route of Admission into acute and sub acute hospital to bypass ED • Complex management in the community
War Memorial’s GFS • Referrals come through NNARC • Referrals from anyone who has contact with the client • Paperless, mobile computer systems • CHIME data base • 12-16 weeks
Adventure Before Dementia
War Memorial’s GFS • • • • Saved lives Improved functioning and QOL Prevented clients going into RACF Prevented clients advancing from low level to high level care • Prevented ED presentations • Prevented ambulance use • Secured permanent funding
St. George Flying Squad • COAG funded • April 2012 • Stand alone Nurse Practitioner - currently a transitional Nurse Practitioner • 9-5pm, Monday to Friday • Residential aged care facilities only • 35 facilities
St. George Flying Squad • Referrals come from the hospital, post discharge and from the Residential aged care facilities • acute illness • clinical deterioration, cellulitis, respiratory tract infection, urinary tract infection, delirium, falls and support for RACF staff for patients with complex nursing issues • Referrals through ARC Acknowledgement to Mary Kearns TNP St. George GFS
Sutherland Flying Squad • • • • • • COAG and NPACT funding Geriatrician and Nurse Practitioner 8am-9pm, Monday to Friday Average response time 80 minutes Referrals only from the aged care facilities 25 facilities
Sutherland Flying Squad • Acute deterioration requiring ED transfer • Assessment and management in aged care facility • IV antibiotics, IV/subcutaneous fluids, behavioral management, end of life care • Direct hospital admission if deemed necessary • NP also involved in outbreak management, catheter and SPC changes, PEG insertion • Support from community nurses – IV medications, wound management and weekend cover Acknowledgement to Dr. Shikha Jain Staff Specialist and Ange Patras NP Sutherland GFS
Outcomes-Patients • Patient are provided holistic medical and nursing care in their residence • Patients able to remain in their residence for medical management, resulting in: – improved mental wellbeing of patients with cognitive disorders – patients remaining in their home for end of life care – increased patient, family, carer satisfaction
Outcomes for patients • Decreased patient anxiety and stress related to changing environment, transportation and hospitalisation • Patient, carer and family satisfaction
Outcomes health care system • • • • Reduced ED presentations Reduced Acute hospitalizations Reduced demand on ambulance services Efficiency savings
Impact on RACF • Availability of specialist education and resources • Staff confidence in managing acutely unwell patients • Streamlining of staff workload • Implementation of end of life care pathways • Staff satisfaction
Geriatric Flying Squads $$$ Savings War Memorial $166,825 in 12 months St. George $300,000 in 7 months Sutherland $430,000 in 12 months
Healthy at Home • Set up as part of the Safte program – clinical redesign by DOH in 2005 • 4 sites – Newcastle, St. George, Queenbeyan and Hornsby • Only Newcastle and St. George still exist • Partnership of the area health services and community options for rapid response to community based elderly at risk of hospitalization
Healthy at Home Newcastle • Part of the HNELHD Greater Newcastle Cluster Community Acute Post Acute Care (CAPAC) Service • Healthy at Home, Hospital in the Home and Transitional Aged Care all under one umbrella • 7 day a week service • Nurse co-ordinated • Multidisciplinary team with a geriatrician
Healthy at Home Newcastle • Referrals from anyone who comes in contact with the client • 48 hour response time • Up to 6 week duration – refer on • 30 - 40 referrals a month • Community partnership – able to get services in immediately • Very similar to War Memorial Flying Squad
Healthy at Home Newcastle • • • • • • Aged over 65 yrs (45yrs for ATSI) Complex clients Absence of recent medical interventions Challenging social situations Hoarding and squalor Falls/ decreased mobility, declining cognition, poly-pharmacy, continence issues • Acknowledgment to Sandy Ryan and Jacqueline Greenham : LNELHD – Greater Newcastle Cluster - CAPAC Service
David A CASE STUDY
David • 83 yo gentleman, referred by ACAT • Living in squalid boarding house accommodation in Kings Cross • Retired lawyer who had lost his fortune • One niece in the blue mountains
David • • • • • • • Issues Cognitive decline OA in his knees COPD High bath tub No services Squalid accommodation – was happy to move but wanted to live independently, and wanted to stay in the cross
David • • • • • Multi-disciplinary involvement Nursing – case management Social Work –housing and services Geriatrician – diagnosis and management Physiotherapy
David • • • • • Knee replacement Rehabilitation Eviction Rehoused in a low care facility in Redfern A happy ending
Future Plans for War Memorial’s GFS • 7 day a week service • Expand into Residential aged care facilities • Research into benefits of community program
Contact Details Amanda Klahr – Clinical Nurse Consultant Geriatric Flying Squad War Memorial Hospital 125 Birrell St, Waverley 2024 Tel. 9369 0313 or 0457 559 253 firstname.lastname@example.org
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