Abstract
IntroductionResidential aged care facility (RACF) residents frequently present to the emergency department (ED) and are often admitted to hospital. Some presentations and admissions may be avoidable. In 2013, Bankstown‐Lidcombe Hospital introduced a subacute geriatric outreach service (SGOS), which had little impact on reducing ED presentations. In 2015, Bankstown‐Lidcombe Hospital introduced an acute geriatric outreach service (AGOS), a geriatrician‐led team that assesses and treats acutely unwell patients in RACFs. We aim to determine whether the AGOS reduces the risk of hospital admission for RACF residents.MethodsHospital admissions data from 2010 to 2019 were used to conduct an interrupted time series (ITS) analysis. AGOS activity data were also summarized.ResultsThe average number of admissions from RACF per month declined from 42.8 during the SGOS period to 27.1 during the AGOS period. The difference of 15.7 admissions from RACF per month was statistically significant (95% CI 12.1–19.2; P < .001). After the introduction of the AGOS, the risk of admission to our geriatric department from RACFs was reduced by 36.1% (incidence rate ratio =0.64; 95% CI: 0.58–0.71; P < .001) compared to the SGOS period, adjusting for seasonality.DiscussionThe AGOS probably reduced the risk of hospital admission for RACF residents.
Highlights
Residential aged care facility (RACF) residents frequently present to the emergency department (ED) and are often admitted to hospital
We have previously shown that there was a decrease in the number of ED presentations from RACFs after the introduction of the acute geriatric outreach service (AGOS).[11]
Negative binomial regression showed that during the AGOS period, risk of admission to our geriatric department was reduced by 36.1% compared to the subacute geriatric outreach service (SGOS) period, adjusting for seasonality
Summary
Australians aged 65 and older are projected to rise from 15% in 2016 to 19% by 2030.1 Over 170, 000 adults aged 65 and older live in residential aged care facilities.[2]. RACF residents are at greater risk of emergency department (ED) representations and hospital readmissions.[4] They present to EDs at rates of 0.1–1.5 transfers per RACF bed/year.[5] Up to 60% of these presentations are subsequently admitted to hospital.[6,7] These ED presentations and hospital admissions can potentially be avoided by treating patients safely in the RACF. This can reduce incident delirium from entering a new environment, nosocomial infections, medication errors, pressure injuries, falls, and resource utilization.8-10.
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