Transcript SA Health PowerPoint Template

Statewide Older People Clinical
Network
Reflection on progress to date
November 2011
Outline
> Hospital capacity and why coordinated
geriatric services are important
> Area Geriatric Service
> Community Geriatric Service
> Inpatient GEM
> Rural GEM
SA Health
Challenges for Australian
Hospitals
SA Health
.2
0.5%
Fraction
A 20 bed ward had 600
bed days available per
month
.1
Upper trim point
5%
0
0
10
Inlier
20
Length of stay
30
40
Long stay Outlier
SA Health
Two compartment model
> Inliers.
• Short LOS, rapid turnover, large numbers
relatively homogeneous
• Improving capacity needs global solutions
making small changes for lots of patients
> Outliers
• Small numbers, long LOS and slow turnover
relatively heterogenous
• Improving capacity needs individualized
approaches
SA Health
Summary of Blue Dot Patients Discharged May to August 2010
*excludes mental health
Site
Blue Dot Progressing
#
ALOS2
Blue Dot with Barrier
#
Site Total Blue Dots
ALO
#
ALOS2
S
2
FMC
257
34
30
851
287
40
NHS
37
22
10
42
47
26
RGH
136
38
65
43
201
42
RGH REHAB
23
56
5
1041
28
45
Total
453
110
563
SA Health
Pathways for Transition to Community:
data excluding subpathways
FMC, NHS, RGH, RGHRehab
May - Aug 2010
CAP, 9, 2%
TCP, 67, 12%
Died, 28, 5%
SRF, 3, 1%
REHAB, 100, 17%
HLC, 166, 29%
CAP
Died
HLC
home
hosp
LLC
REHAB
SRF
TCP
LLC, 31, 6%
hosp, 76, 14%
home, 75, 14%
SA Health
Sub-pathways
FMC, NHS, RGH, RGHRehab
May - Aug 2010
cald , 2, 2%
atsi , 1, 1%
behaviour , 20, 18%
dsa , 21, 19%
gsb , 16, 14%
conflict , 25, 22%
behaviour
conflict
country
gsb
dsa
atsi
cald
country , 28, 24%
SA Health
Unlocking the 3rd Compartment
> Moving to a subacute care environment is
an important capacity solution for acute
care
> Some forms of subacute care give better
outcomes for older people
> Possible compartments
• GEM, Rehabilitation, Transition care, Care
awaiting Placement
SA Health
3rd Compartment
> All of these forms of subacute care to
work well need to be working together
> Avoiding a blue dot path is more efficient
than committing a patient to a path
> Links with TCP and TRAC to rehab and
GEM beds can improve their efficiency
SA Health
Older People Clinical Network
SA Health
Our journey so far
> August 2009 to Feb 2011 we established working
parties and drew up plans for
• An Area Geriatric Service (LHN based )
• Rural model of Geriatric Evaluation and
Management (GEM)
• Urban inpatient GEM model of care
• Community Geriatric Service
• Care of older people in hospitals
> Feb 2011 to now
• Discuss next steps for these plans
• Liaise with site general managers, CEOs of the
LHNs around implementation issues
• Liaise with DH
• Work on Acute Care of the Elderly units and
Geriatric Liaison services
• Work on Nurse Practitioner roles
SA Health
Vision for Specialised Geriatric
Services
> Specialist care for older people in a given
population of SA (i.e. not hospital or community
based)
> Focus on the frail elderly who are at risk of
transition into residential care and losing their
ability to participate in the general community
> The goal is to improve their health status to allow
older South Australians and their carers avoid
moving into residential, and if not, to better plan
the transition
> The Area Geriatric Service and the Mental Health
Services for Older People will provide the
specialist dementia care for older South
Australians
> Rehabilitation services has a significant role to
manage this transition
SA Health
Area Geriatric Service
- Current status
> Specialised care of older people
fragmented across a range of services
and organisations
> Older people, their families and other
professionals experiencing difficulty
accessing the care they need
> Services not evenly accessible across SA
Health, or even Adelaide itself
> Default mechanism – transfer to ED, care
provided in acute hospital
SA Health
Area Geriatric Service proposed
> Establishment of integrated specialist geriatric
services across each Local Health Network
> Each service will provide a range of services and
components of care – community and hospital
settings
> Target is older people with geriatric syndromes
and functional decline
• Minimise functional decline
• Better manage the transition into residential care
> Will provide support to residential aged care
SA Health
AREA GERIATRIC SERVICE
Core services
Can be provided by geriatricians,
rehabilitation or stroke physicians
INPATIENT GERIATRIC SERVICES
MAJOR HOSPITAL
GENERAL HOSPITAL
• Acute Care of Elderly (ACE)
Unit
• Geriatric Liaison services
o Emergency department
o Acute Medical Unit (AMU)
o Triage to GEM, Transition
Care Program (TCP),
Aged Care Assessment
Team (ACAT),
Rehabilitation
o Psycho geriatric
o Orthogeriatric
o Stroke
o Country
• Geriatric Evaluation and
Management (GEM)
Unit
• Geriatric Liaison services
o Emergency
department
o Triage to GEM, TCP,
ACAT, Rehabilitation
o Psycho geriatric
o Orthogeriatric
o Stroke
o Country
COMMUNITY GERIATRIC SERVICES
• Comprehensive Geriatric Assessment
(CGA)
• Case Management/care coordination
• Falls prevention and management
• Dementia Assessment
• Community Rehabilitation , including
Day Rehabilitation Centres (integrated
with Rehabilitation stream)
• Transition Care Program
• Transition to Residential Aged Care
• Aged Care Assessment
• Continence Assessment
• Outpatients
SA Health
Key Recommendations
> Strong partnership between clinical and
administrative governance of service within each
LHN
> Develop Area Geriatric Service in Northern
Adelaide Local Health Network – Modbury
Hospital requires infrastructure, specialist support
> Further work on Acute Care of the Elderly model –
LMH a particular need
> Address discrepancies in staffing GEM model and
shortfall of GEM beds need to be addressed
> Access to community and home based
rehabilitation be developed as component of the
Community Geriatric Service
SA Health
Inpatient GEM
> Detailed a model of care which is
fairly similar across Adelaide
> Established standards for staffing
> Audited current standards and
there is a wide variability in staffing
> Established outcome measures for
the GEM units
SA Health
Community Geriatric Service
> Created a new entity
> Identified the critical components
> Most of these components exist to some extent
already, but they are not integrated
> Developed a detailed model of care for falls in
particular
> Providing a service that can manage the transition
into care outside the hospital walls
> Relationship with ACAT needs clarification as
does the relationship with NGOs
SA Health
Key Recommendations
> The creation of this service under a
unified governance arrangement will
require major changes for the primary
and population health services in
Adelaide
> Base for a northern service ideally at
Modbury
> Community rehabilitation is a major gap
in services
SA Health
Rural GEM model
> There is a very detailed model of care for
rural GEM teams
> We have developed a process for getting
geriatricians out to the country
> The model of care best matches
elements of the city based community
geriatrics model ( CGA, dementia
assessment mostly)
SA Health
Key Recommendations
> That we need to consider how we deliver
other elements of the LHN Area Geriatric
Service in rural areas
• Inpatient services
• Falls prevention
> How we deliver GEM program to smaller
rural and remote areas
SA Health
Other work
> Care of Older People in Acute Hospitals
workgroup will complete its project in June 2012
> Nurse practitioners workgroup has been
established and developed a scope of practice
> ACE and liaison services needs to complement
the rest of the LHN geriatric service document
> Relationship with rehabilitation services and the
LHN geriatric service needs defining
> Relationship with NGOs around the LHN Area
Geriatric Service (around referrals in and
discharge to those services)
> Supporting a piece of redesign work around the
southern LHN and transition care
SA Health