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 email@example.com
Calcification Inhibitors in CKD and Dialysis Patients
Amanda Klahr, Clinical Nurse Consultant, Geriatric Flying Squad, War Memorial Hospital Waverley delivered this presentation at the 2013 Hospital in the ...
Working at War Memorial. Support Centre. TeamLab Portal. Campus Meeting Rooms Bookings. Campus Clinic Rooms bookings. ... War Memorial Hospital Waverley .
Waverley is an eastern suburb of Sydney, ... This distinguished group of Victorian buildings is now used as the War Memorial Hospital. Edina, ...
Waverley Private Hospital. Menu. Home. About Us. About Our Hospital; History; Location; Mission and Vision; ... Waverley Maternity Unit; Why Choose Us ...
Flying squad stars at aged care forum Flying squad ... Amanda Klahr. Amanda Klahr ... Developed at the War Memorial Hospital in Waverly Park, ...
The Geriatric Flying Squad GFS. ... The service also has access to all the services at War Memorial Hospital ... War Memorial Hospital Waverley An ...
Geriatric flying squad. Amanda Klahr, ... Developed at the War Memorial Hospital in Waverly Park, the service provides comprehensive geriatric ...