A Nurse Practitioner candidate : A model for change in aged care

Abstract

Objective: A Nurse Practitioner Candidate (NPC) working in Aged Care recognised that there were occurrences of relative General Practitioner shortage created by elderly people’s decreased access totimely GP Services. The demands of GP practice meant GP’s could not always attend to Residential Aged Care Facilities (RACF) promptly1,2. In addition, much discussion has centred on the high rates of potentially avoidable RACF residents presenting to Emergency Departments (ED) 3-7.To address part of this issue a NPC was implemented within a Residential Aged Care Facility to determine if an on-site advanced practice nurse could have an effect on reducing the number of unnecessary hospital presentations for residents with increasing healthcare needs whilst simultaneously augmenting GP services with minimal added cost to the health care system. Design: Quasi-experimental pre and post intervention design Method: A NPC and collaborative partners successfully obtained a grant from Department of Social Services to fund the NPC role and research project. A NPC was intentionally chosen as the least confronting change-agent to build inter-disciplinary relationships with GP’s, RACF Nurses and carers as successful collaboration would be crucial to project success. The NPC role commenced the Health Intervention Project for Seniors (HIPS) as one subset of a larger research project. Results: Data analysis of the formal research project has now been undertaken with favourable results including: Decreased number of transfers to ED; those transferred were more appropriate; and shorter Length of Stay was observed compared to pre intervention; The reduction in avoidable transfers equated to cost savings for the health service. Compared to other RACF’s in the health service district Sundale demonstrated a lower average cost per resident transferred. Conclusion: Despite measurable cost savings to the state health service and smaller gains to the local GP service, this model demonstrated no cost advantage to the Residential Facility