Expand Hospital in the home principle for potential emergency admissions

Liaise with GP association and Qld ambulance, aged care providors, create a home visit service staffed by Emergency Department Nurse Practitioners (NP) and GP's. 

1. Change ED access so that all non urgent admission must call prior to attending as they would for a GP visit - calls are triaged

2. Patients on the calls list deemed non urgent are provided with a home visit/health check by the Hospital based ED NP and or GP

3. Nursing home patients in particular can be triaged and treated in their place of care by the hospital emergency treating team, ie IV inserted , rehydration fluids given, IV A/B's where appropriate commenced and continued in the aged care facility.

 

 

Why the contribution is important

Reduce the burden on ED departments, resuce wait times for higher acuity ED patients, minimise the 'ramping' of ambulance patients, reduce the acute hospital admissions of the very aged and frail who are living in care.

by tanneral on August 13, 2019 at 10:55AM

Current Rating

3.5
Average score : 3.5
Based on : 2 votes

Comments

  • Posted by kathyk August 13, 2019 at 15:27

    Yes, this is a great idea!!

    I once spent 6 hours waiting in an ED corridor with my grandmother (96 years, with dementia) who was sent in by her NH in the wee hours. In the end I took her home without being seen, and after being accused by a social worker of being aggressive because I asked when we would see someone!!! (I worked in the same hospital at the time, so I definitely WAS NOT aggressive!)

    ED is the blockage - the problems need to be sorted:
    (1) prior to the blockage, ie. in the community
    (2) at the blockage, ie. the process issues within the ED itself, and
    (3) after the ED, ie. once moved from ED

    I would suggest practitioners with extended scope of practice be involved in the home visit service to make it run smoothly. For example, specialist ambulance officers with capacity to write scripts, do the IVs etc. Once you get extra professions involved (GPs, ED NPs) the system will become more complicated to organise and manage, also more expensive.

  • Posted by Mwann August 24, 2019 at 06:54

    hi there Guys,

    tanneral, i love the idea and something that i can see very clearly. kathyk, this idea aready is starting to grow within the QAS with the development of the LARU (Local Area Referral Unit), these officers have a passion for the "low acuity, complex pt. currently they undertake a further 12 months of study focused on physical assessment skills and developing a greater understanding of the complex medical pt. this model exists in other states and internationally.
    I have stated in other posts that some of us are starting down masters programs further developing our understanding and capability in this area.
    In this case, the development of a consult process via phone/person with other clinicians such as NP/GP/MO this would ensure pharmacy could be provided if determined necessary.

    anyway love the idea guys.
    Mwann
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