Length of stay and the four hour target: A retrospective audit of emergency department presentations by Residential Aged Care patients

2011 ◽  
Vol 14 ◽  
pp. S4-S5
Author(s):  
Maryann Street ◽  
Patricia Livingston ◽  
Jonathan Marriott
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Aged Care ◽  
Residential Aged Care ◽  
Retrospective Audit

scholarly journals Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

2021 ◽  
Vol 9 ◽  
Author(s):  
Jo-Aine Hang ◽  
Jacqueline Francis-Coad ◽  
Chiara Naseri ◽  
Angela Jacques ◽  
Nicholas Waldron ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Care Service ◽  
Aged Care ◽  
Functional Improvement ◽  
Residential Aged Care ◽  
Discharge Destination ◽  
Transition Care ◽  
Retrospective Audit ◽  
Health Related

Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement.Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling.Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)].Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.

scholarly journals The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis

2020 ◽  
Author(s):  
Hannah Carter ◽  
Xing J. Lee ◽  
Trudy Dwyer ◽  
Barbara O’Neill ◽  
Dee Jeffrey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cost Effectiveness ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Care Facility ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
Residential Aged Care Facility ◽  
The Cost

Abstract Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia. Methods: A prospective pre-post cohort study design was used to collect data on costs of program delivery, hospital admission rates and length of stay for the 12 months prior to, and following, the intervention. A Markov decision model was developed to synthesize study data with published literature in order to estimate the cost-effectiveness of the program. Quality adjusted life years (QALYs) were adopted as the measure of effectiveness. Results: The EDDIE program was associated with a 19% reduction in annual hospital admissions and a 31% reduction in the average length of stay. The cost-effectiveness analysis found the program to be both more effective and less costly than usual care, with 0.06 QALYs gained and $249,000 health system costs saved in a modelled cohort of 96 residents. A probabilistic sensitivity analysis estimated that there was an 86% probability that the program was cost-effective after taking the uncertainty of the model inputs into account. Conclusions: This study provides promising evidence for the effectiveness and cost-effectiveness of a nurse led, early intervention program in preventing unnecessary hospital admissions within a residential aged care facility. Further research in multi-site randomised studies is needed to confirm the generalisability of these results.

scholarly journals The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care

2020 ◽  
Vol 32 (8) ◽  
pp. 502-510 ◽  
Author(s):  
Maria C Inacio ◽  
Catherine Lang ◽  
Gillian E Caughey ◽  
Sarah C E Bray ◽  
Stephanie L Harrison ◽  
...  
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Premature Mortality ◽  
Antibiotic Use ◽  
Aged Care ◽  
Residential Aged Care ◽  
Quality And Safety ◽  
Opioid Use ◽  
Outcome Monitoring ◽  
Chronic Opioid Use

Abstract Objectives To introduce the Registry of Senior Australians (ROSA) Outcome Monitoring System, which can monitor the quality and safety of care provided to individuals accessing residential aged care. Development and examination of 12 quality and safety indicators of care and their 2016 prevalence estimates are presented. Design Retrospective. Setting 2690 national and 254 South Australian (SA) aged care facilities. Participants 208 355 unique residents nationally and 18 956 in SA. Main Outcome Measures Risk-adjusted prevalence of high sedative load, antipsychotic use, chronic opioid use, antibiotic use, premature mortality, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium and/or dementia hospitalisations, emergency department presentations, and pressure injuries. Results Five indicators were estimated nationally; antibiotic use (67.5%, 95% confidence interval (CI): 67.3–67.7%) had the highest prevalence, followed by high sedative load (48.1%, 95% CI: 47.9–48.3%), chronic opioid use (26.8%, 95% CI: 26.6–26.9%), antipsychotic use (23.5%, 95% CI: 23.4–23.7%) and premature mortality (0.6%, 95% CI: 0.6–0.7%). Seven indicators were estimated in SA; emergency department presentations (19.1%, 95% CI: 18.3–20.0%) had the highest prevalence, followed by falls (10.1%, 95% CI: 9.7–10.4%), fractures (4.8%, 95% CI: 4.6–5.1%), pressure injuries (2.9%, 95% CI: 2.7–3.1%), delirium and/or dementia related hospitalisations (2.3%, 95% CI: 2.1–2.6%), weight loss/malnutrition (0.7%, 95% CI: 0.6–0.8%) and medication-related events (0.6%, 95% CI: 0.5–0.7%). Conclusions Twelve quality and safety indicators were developed to monitor aged care provided to older Australians based on the synthesis of existing literature and expert advisory input. These indicators rely on existing data within the aged care and healthcare sectors, therefore creating a pragmatic tool to examine quality and unwarranted care variation.

scholarly journals Electronic prescribing and medication management at a residential aged care facility

2016 ◽  
Vol 07 (01) ◽  
pp. 116-127 ◽  
Author(s):  
Cik Lee ◽  
Safeera Hussainy ◽  
Rohan Elliott
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Care Facility ◽  
Aged Care ◽  
Electronic Prescribing ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
Training Support ◽  
Retrospective Audit ◽  
Residential Aged Care Facility

SummaryA cloud-based mobile electronic prescribing and medication management system (ePMMS), in which prescribers’ orders directly populate residential aged care facility (RACF) medication administration records (MARs) and are communicated electronically to the RACF’s pharmacy, may create efficiencies and improve patient safety when compared to the paper-based and hybrid paper-electronic medication management systems used in most Australian RACFs. Little is known about general-practitioners’ (GPs’), nurses’ and pharmacists’ acceptance of, or experiences with, ePMMS.To explore the uptake of an ePMMS by GPs, and the experiences and perceptions of GPs, nurses and pharmacists, at a 90-bed RACF that tested a beta-version ePMMS.Retrospective audit to determine the proportion of medicines ordered by GPs via the ePMMS over a three-month period. Focus groups conducted three-to-four months after implementation: one with GPs (n=5), one with nurses (n=12); in-depth interview/survey of pharmacists (n=2). Qualitative data were analysed thematically.Three of seven GPs used the ePMMS to order medicines; 53/205(25.9%) medicines were ordered via the ePMMS by GPs.Two broad themes were identified: benefits of the ePMMS, and barriers/limitations. Benefits related to patient safety and workforce efficiency, and included GPs’ ability to access and modify residents’ MARs remotely, no need for nurses to fax orders to the pharmacy, and no need for pharmacy transcription of GPs’ handwritten orders to create electronic MARs. Barriers and limitations related to inefficiency, low GP uptake and training/support, and included slower prescribing compared to written orders, the need for GP-signed paper copies of the MAR, lack of integration with GP clinic software, and low GP motivation to use the system, especially GPs with few patients at the RACF.GPs, nurses and pharmacists felt the ePMMS improved medication-safety and workforce-efficiency, however a number of barriers were identified that contributed to low GP-uptake and limited the benefits.

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