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Reducing hospitalisations in residential aged care

Photo: Reducing hospitalisations in residential aged care
The population is ageing and efforts are underway around the world to ensure healthcare systems are equipped to keep up with healthcare demand.One important solution to overcome the growing pressure on hospitals is to reduce the number of emergency transfers from residential aged care facilities.

Frailty and multiple comorbidities place residents of residential aged care facilities at high risk of emergency transfers to hospital, although many of these can be unnecessary or preventable.

A team of CQUniversity Australia researchers have been working in close partnership with aged care management and staff from PresCare, a regional not-for-profit aged care organisation since 2013.PresCare invited CQUniversity researchers to independently evaluate their Sub-Acute Care Program, developed to reduce the hospitalisation of the residents in their aged care facility.
Their goal was to create a program that empowers the nursing staff to detect signs of deteriorating resident health early and to manage the condition within the residential aged care facility.

The program includes decision-support tools, resources and training, and is based on a three-step ‘traffic light’ system that aims to detect, assess and treat eight clinical conditions that commonly lead to hospital admission. In recognition of the successful outcomes of the program, PresCare received the HESTA Aged Care Award in 2016 for team innovation.

The one-year evaluation study, led by Professor Lynne Parkinson, with co-researchers Associate Professor Trudy Dwyer, Professor Kerry Reid-Searl, and Doctor Barbara O’Neill, commenced in January 2014 and considered evidence from administrative data, a literature review, focus groups, and pre and post surveys.

The research team compared two years of historica administrative data on the residential aged care facility’s hospital admissions with administrative data after the program’s introduction and found that there were fewer hospital transfers and more subacute care of clients being provided at the facility after program implementation.

There was also evidence of substantial learning and development outcomes for nursing staff.

The final report outlined a number of recommendations to facilitate the implementation of the program in other PresCare residential facilities across Queensland. T

hese recommendations included providing detailed information to all stakeholders, including clients, family members, and community representatives and involving them in the process.

The researchers also advised that any future rollouts should be introduced in stages and carefully evaluated to ensure all stakeholders know about and understand the benefits. Given the improvements to healthcare delivery at the first study site, PresCare again partnered with the CQUniversity team and received research funding from the Australian Centre for Health Services Innovation (AusHSI) to develop a framework to translate this new knowledge into practice.

The project called, Early Detection of Deterioration in Elderly residents (EDDIE) study, led by Associate Professor Trudy Dwyer and Professor Lynne Parkinson, along with the original team, evaluated the implementation of the PresCare Sub-Acute Care Program and associated costs at a second residential aged care facility.

Again there was evidence of staff and outside stakeholders favourably supporting the program’s implementation. With the Sub-Acute Care Program in place, fewer residents were transferred to hospital when compared to previous years, and when they were admitted, their lengths of stay in hospital were shorter. This project highlight’s CQUniversity’s practical approach to research, partnering with industry organizations to come up with real-world solutions.

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