Change Narrative Abstract - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Geriatrics in the Home – Emergency Department Clinical Nurse Pilot (#210)

Sally Johns 1 , Alice Bourke 1 , Emily Lines 1
  1. Northern Adelaide Geriatrics Service, Northern Adelaide Local Health Network, Adelaide, SA, Australia

Background: Additional Geriatrics In The Home (GITH) beds were opened to support the acute hospitals in the Northern Adelaide Local Health Network (NALHN). NALHN has a growing ageing population with high levels of socioeconomic disadvantage, lower Life expectancy and higher levels of chronic disease than other South Australian (SA) metropolitan Local Health Networks

In NALHN older people spend more time in the Emergency Department (ED), with an average length of stay for all presentations of 6.6 hours, 9.8 hours for those over 65 years and 10.8 hours for those over 85 years and 80% of people aged over 85 years presenting to ED are admitted.

Change: A GITH ED Nurse pilot was implemented with the following aims to support admission to the additional GITH beds:

  • Facilitate direct admission from ED to GITH
  • Facilitate direct admission from Residential Aged Care Facilities (RACFs) to GITH via the SA Ambulance Service and SA Virtual Care Centre
  • Facilitate timely transfer from ED to inpatient beds when required

89 patients were identified by the GITH ED Nurse during the pilot. 82% of patients were admitted to the Acute Care of the Elderly (ACE) in-hospital beds. 36% of those admitted to ACE were transferred to GITH, enabling earlier supported discharge from the acute hospital.

Learnings: The GITH ED Nurse pilot enabled the identification of patients for acute geriatrics inpatient admission.

The pilot did not include senior medical staff or allied health staff who would have contributed further to comprehensive multi-disciplinary assessment to enable the prognostication and decision making required to determine which patients could be best treated in an out of hospital setting. Other factors limiting patient evaluation likely include under-triaging, poor appreciation of complexity and atypical presentations in older patients.

The pilot did not see an increase in patients directly admitted to GITH from RACFs. Following review of this pilot, further programs have been designed including a same-day in-reach response which has successfully supported residents to remain in place with high levels of patient, facility and GP satisfaction reported.

The short-term nature of the program did not facilitate relationship building with key stakeholders or support recruitment of skilled staff.