Amanda Klahr, War Memorial Hospital Waverley - Geriatric Flying Squads - A new age in geriatric community management
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share

Amanda Klahr, War Memorial Hospital Waverley - Geriatric Flying Squads - A new age in geriatric community management

  • 381 views
Uploaded on

Amanda Klahr, War Memorial Hospital Waverley delivered the presentation at the 2013 Hospital in the Home Conference. ...

Amanda Klahr, War Memorial Hospital Waverley delivered the presentation at the 2013 Hospital in the Home Conference.

The Hospital in the Home Conference is a nurse oriented program packed with comprehensive case studies to improve HITH services and maximise hospital efficiency throughout Australia.

For more information about the event, please visit: http://www.communitycareconferences.com.au/HITHevent

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to like this
No Downloads

Views

Total Views
381
On Slideshare
381
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
1
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Geriatric Flying Squads A new age in geriatric community management
  • 2. 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.
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. Adventure Before Dementia
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. Outcomes for patients • Decreased patient anxiety and stress related to changing environment, transportation and hospitalisation • Patient, carer and family satisfaction
  • 17. Outcomes health care system • Reduced ED presentations • Reduced Acute hospitalizations • Reduced demand on ambulance services • Efficiency savings
  • 18. 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
  • 19. Geriatric Flying Squads $$$ Savings War Memorial $166,825 in 12 months St. George $300,000 in 7 months Sutherland $430,000 in 12 months
  • 20. 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
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. A CASE STUDY David
  • 25. 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
  • 26. 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
  • 27. David • Multi-disciplinary involvement • Nursing – case management • Social Work –housing and services • Geriatrician – diagnosis and management • Physiotherapy
  • 28. David • Knee replacement • Rehabilitation • Eviction • Rehoused in a low care facility in Redfern • A happy ending
  • 29. Future Plans for War Memorial’s GFS • 7 day a week service • Expand into Residential aged care facilities • Research into benefits of community program
  • 30. 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 amanda.klahr@sesiahs.health.gov.nsw.au
  • 31. Any Questions?