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CARE-PACT pathway improving the journey for acute aged care

15 May 2014

A pilot program at Princess Alexandra Hospital (PAH) has tailored a model of care for frail patients from residential aged care facilities with the additional benefit of a 31.17% reduction in emergency department presentations from this group.

CARE-PACT is a unique demand management program that focuses on streamlining and educating the care pathway for the frail elderly residents of aged care facilities.

Clinical nurse consultant Dawn Bandiera, and emergency physicians Dr Raelene Donovan and Dr Ellen Burkett have been granted a Health Innovation Fund grant to explore the demand and complex clinical assessment required by patients from aged care facilities in an attempt to reduce the impact of unnecessary travel on this complex group and consequently reduce avoidable presentations to Emergency.

“The primary reason for creating the CARE-PACT model of care has been to improve the quality of care provided to residents where their acute health care needs require emergency physician review. A secondary effect of this program is anticipated to be a reduction in avoidable emergency department presentations, which has already been demonstrated by a pilot of the program at PAH” Dr Burkett said.

“Transferring a frail and elderly patient between care facilities can be distressing, so if it can be avoided with a greater partnership between our team and theirs, then we are preventing unnecessary stress on the patient.”

Second to that, their partnership with aged care facilities focuses on up-skilling nursing staff and attending GP’s in the aged care setting, to determine the least distressing intervention for the patient or expediting emergency care for the deteriorating patient, where this is required.

“A single point of contact at PAH and a guideline for managing key conditions is enabling specialist emergency clinical assessment of the patient before the decision is made to transfer them to the Emergency,” she said.

“This approach reduces avoidable presentations by ensuring that the residents’ care needs are met in the way that causes least distress, and maximal benefit, to the resident.”

“Where the condition of the patient is deteriorating, this triage approach and clinical care planning will expedite referral to our acute specialist services or support GPs and facility staff to undertake care within the facility.”

There are four main components to the CARE-PACT:

  1. Telephone triage to reduce avoidable emergency department presentations using a single point of contact to enable specialist emergency nursing clinical assessment of deteriorating patients.
  2. An ED and inpatient resource to maximise early discharge back to GP or residential aged care facility through collaborative discharge planning.
  3. An ED-equivalent mobile assessment service in the aged care facility to reduce avoidable presentations to ED.
  4. A pathway to expedite referral to specialist services directly from the RACF or substitution of these services within the aged care facility by a variety of community services according to key eligibility criteria.

“One of the important things we hoped to address with the guideline and training of staff through CARE-PACT, was an improvement in their skill mix and resources, the perceived risk of not transferring the patient to our acute environment, and the complications of functional and cognitive impairment of many patients from those facilities.”

CARE-PACT is a partnership with Princess Alexandra Hospital, aged care facilities, GPs and the Brisbane South PHN.

Last updated 8 January 2018
Last reviewed 6 March 2015

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