247 Assessing the impact of a new integrated care framework for nursing home residents

Abstract

Abstract Background Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals. Methods A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records. Results 174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments. Conclusion Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.