Maria Draper & Bonnie PimmPrincess Alexandra Hospital, Brisbane

Poster produced by Multi Media Unit, Princess Alexandra Hospital

The GATE program is an aged care assessment and liaison program that advocates for elderly

patients admitted to Princess Alexandra Hospital. It addresses timely review for patients

referred to geriatric rehabilitation, and for approval to residential care, and/or Transition

care programs.

Poor referral pathways for elderly patients had resulted in delays in referrals and duplication

of assessments. This resulted in increased length of stay and decline of the elderly patient.

GATE has streamlined referrals and uses a comprehensive and integrated geriatric assessment

for patients over sixty five to improve patient outcomes.

The implementation in July 2007 focused on single point of referral, Comprehensive Geriatric

Assessment (CGA) of elderly patients by gerontic nurses, data entry into an electronic patient

record, geriatrician review and a formal report produced for the patient records.

The use of technology and management of GARU waiting list by the GATE team has significantly

improved outcomes for the elderly patients

Attention is paid to geriatric syndrome and rehabilitation potential is explored. Elderly

patients are put in right service first time and when ready. The average wait for patients on

the GARU waiting list is < 2 days.

Waiting time for ACAT assessment is now minimal. At time of this report there were only five

age appropriate patients (65 years and greater) in the 600 bed acute care hospital waiting

for ACAT assessment or nursing home placement.

Prior to the commencement of GATE these patients caused significant bed block. 32 % of

patients referred to GATE for ACAT assessment have returned to their home.

The clear referral pathway and early comprehensive geriatric assessment has resulted in

greater than 95% of patients assessed within 2 working days of referral, an increase in patient

throughput in GARU by 25% and a decrease in median LOS by 4 days while the acuity and

complexity of the patients increases.

Destination of ACAT referrals to GATE

Previous referral pathway Proposed Model

Days Awaiting GARU

LOS Admissions by Year

“Geriatric” referral

Geriatrician support

Single Comprehensive

Geriatricassessment

Needs Based

-Geriatric Rehabilitation-Advice-Residential Care-TransitionCare-Community Care

0.0

2.0

4.0

6.0

8.0

1 2 3 4 5 6 7 8 9 10 11 12

Month

Avera

ge D

ays 2007

2008

2009

2010

Other4%

Deceased10%

Hospice facility / palliative care unit

2%

Home32%

Hospital7%

Residential care45%

Other

Deceased

Hospice facility / palliative care unit

Home

Hospital

Residential care

LOS

0.00

10.00

20.00

30.00

40.00

50.00

60.00

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Ave

rage

LO

S

Admissions by Year

0

100

200

300

400

500

600

700

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Num

nber

The Princess Alexandra Hospital (PAH) is a tertiary teaching hospital in Brisbane, Australia. The Geriatric Assessment Through E-Health (GATE) team have developed an innovative partnership in care delivery of aged care services using an integrated approach to geriatric evaluation

and management through the use of a simplified referral and geriatric assessment process. The service now provides a single point of contact for all geriatric services, rapid triage and timely, comprehensive assessment. It was identified that the lack of a clear referral pathway for

the older person in PAH had resulted in a number of inefficiencies created through delays in contacting the correct referral point, duplication of assessment and the need for cross referral from one agency to another, which in turn resulted in increased length of stay and further

deconditioning of the elderly patient. The previous referral process was largely historical and reflected the development of health programs over time with the acute care setting and community services working in silos. Now a comprehensive geriatric assessment and formal

geriatrician review occurs in any case referred for rehabilitation, residential care or transitional care and also on others on a needs basis (dependent on case complexity). An initial electronic report is produced within 24 hours of referral. The separations in GARU have increased

by twenty five percent in two years and inappropriate referrals to ACAT are now non existent. The GATE program facilitates a smoother care path for the elderly patient and improved continuity of care.

Geriatric Assessment Through E-Health:Princess Alexandra Hospital GATE Program