The population of Queensland is ageing and due to advancements in healthcare they are living longer than ever before, many with multiple healthcare conditions. Consequently we have seen a growth in older person presentations to emergency departments (EDs) and subsequent inpatient admissions. These pressures reflect a world-wide phenomenon, related to both ageing populations and the increase of chronic disease in the community. With the expectation that this rate is only likely to escalate, Queensland needs to plan for caring more appropriately for this cohort of patients.
Our Healthcare Improvement Unit (HIU) has undertaken a large program of work in partnership with a number of Hospital and Health Services (HHSs) across the state to improve the care of older persons in Queensland Health facilities. We're working collaboratively with clinicians to understand and better meet the unique care needs of this cohort of patients. This is being achieved by developing clinical decision support pathways for primary healthcare and aged care facility providers, along with implementing models of care to facilitate fast tracking through the emergency department and supported discharges to get people home sooner.
One of HIU's key initiatives is the FRAIL multi-site collaborative project which includes the application of the FRAIL 'bundle' of evidence-based principles and actionable elements to support the work of the local project teams. The project commenced in November 2017 at the Caboolture, Mackay and Townsville hospitals with support from HIU. This included conducting learning sessions (pictured) to provide education and support on project methodology, fortnightly teleconferences to share learnings from each project, and facilitating access to a panel of experts in geriatric care from across the state. The three sites have all commenced their projects and have identified improvements at the local level in the care for older persons.
The FRAIL bundle is:
F – Frailty identification early
R – Rapid assessment against geriatric domains
A – Assertive individualised case management
I – Influencing discharge disposition
L – Listening to the patient - "what matters to me"
Other projects we are undertaking include:
- The scale and spread of the Geriatric Emergency Department Intervention (GEDI) model from the Sunshine Coast Hospital and Health Service to the Cairns and Ipswich hospital emergency departments.
- Development of educational resources to support residential aged care facility staff and general practitioners to care for residents in their homes longer (some project members pictured below at a recent workshop).
- Supporting the Medication Services Queensland trial and roll out of the Emergency Department Discharge Medication Administration Record (EDDMAR), to improve medication management of residential aged care facility patients following an emergency department presentation.
- Contributing to the development of the Queensland Health Older Persons Health Strategy, to set the strategic direction on improving health outcomes.
- Developing educational resources and assessment tools to support Queensland Health clinicians to improve patient and clinician satisfaction of care.
- Development of a central repository of older person care resources to allow healthcare providers outside of Queensland Health to access the resources.
Additional information on some of the work being undertaken to improve the care of older persons across Queensland is available in the Emergency Care Action Plan, the Care-PACT project page, and the GEDI project page.
To keep up to date with other news from the Clinical Excellence Division subscribe to our mailing list or follow us on Twitter or Facebook.
