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

A CASE STUDY

David

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

amanda.klahr@sesiahs.health.gov.nsw.au

Any Questions?