Abstract
Background
To progress with integrated care, for older persons, it was proposed to establish a Day Hospital in a Primary Care Centre. Population data for Co Mayo shows the percentage of those over 65 years, (17.6%), to be significantly higher than the national average
In 2018 there were 39,092 attendances to the Emergency Department and approximately 500, per month, were over 75 years.
The aim was to develop a pathway from the Emergency Department to the Day Hospital for those 75 years and over who had experienced a fall. Additionally, this included an Early Supported Discharge for hip fracture patients.
Methods
The Day Hospital was operational 1 day per week with an allocation of funding for a Consultant, Occupational Therapist and assigned Project Manager.
Holter and Blood pressure monitoring equipment was purchased.
The Home First Team were reassigned to the front door of the hospital and worked with a cANP and a Medical Registrar.
A weekly multi-disciplinary forum, inclusive of all stakeholders, developed working relationships, built a shared vision and standardised the approach for the patient cohort.
Frailty training was provided specifically to Emergency Department staff.
Results
The Home First Team saw 541 patients (Jan-Apr 2019) and in collaboration with the Geriatrician streamed those suitable for management to primary care.
The Integrated Day Hospital, 1 day per week (Jan-Apr 2019) delivered 55 new assessments plus follow-up appointments.
Patient feedback is very positive and specifically highlights ease of access in primary care.
Conclusion
Establishing a Day Hospital in a Primary Care Centre is an innovative approach and shifts the focus of intervention from acute to primary care. The location is ideal due to a range of disciplines on site, PHN, Dietetics, Psychiatry
This is the initial phase, with some pathways in place, and the overall aim is to provide GP access to rapid assessment in Primary Care and thus ensure hospital avoidance where possible.
The Oran Park Story: creating & evaluating an Integrated Primary Care
Centre
