Flying Squads
• flying squad
• n. Chiefly British
• A small mobile unit, especially of
motorized police, capable of moving
quickly into action, as during an
emergency.
Medical Flying Squads
• An Obstetric Flying Squad is a form of
medical retrieval team that is composed of
an obstetrician, anaesthetist, midwife and
other healthcare personnel who are on-call
to attend to mothers with major obstetric
complications occurring in the community.
• Accident and Emergency Flying Squads
Geriatric Flying
Squads • A need for fast response geriatric
community care was identified
• Community dwelling elders were presenting to emergency rooms because the wait for community care was up to 6 months
• Over 50% ED presentations from RACF
were unnecessary and could have been
managed in the facilities with appropriate
care
War Memorial Hospital
• Community based specialist geriatric hospital – ‘one stop shop for the elderly’
• Physio, Hydro, OT, Social Work, Speech Pathology, Continence, clinical psychology, Diet, Falls and Parkinson's clinics, inpatient rehabilitation
• Based in the outpatient dept
• Use of all of the WMH resources
War Memorial’s GFS
• Started in May 2010
• COAG funding
• Nurse led/coordinated
• Multi-disciplinary team including a geriatrician
• Comprehensive Geriatric Assessment
• Short term case management
• Community dwelling and low level RACF
War Memorial’s GFS
• 9-5pm, 5 days a week
• Sub acute program
• Flexibility of service
• Direct route of Admission into acute and
sub acute hospital to bypass ED
• Complex management in the community
War Memorial’s GFS
• Referrals come through NNARC
• Referrals from anyone who has contact
with the client
• Paperless, mobile computer systems
• CHIME data base
• 12-16 weeks
War Memorial’s GFS
• Saved lives
• Improved functioning and QOL
• Prevented clients going into RACF
• Prevented clients advancing from low level to high level care
• Prevented ED presentations
• Prevented ambulance use
• Secured permanent funding
St. George Flying
Squad • COAG funded
• April 2012
• Stand alone Nurse Practitioner - currently
a transitional Nurse Practitioner
• 9-5pm, Monday to Friday
• Residential aged care facilities only
• 35 facilities
St. George Flying
Squad • Referrals come from the hospital, post
discharge and from the Residential aged care facilities
• acute illness
• clinical deterioration, cellulitis, respiratory tract infection, urinary tract infection, delirium, falls and support for RACF staff for patients with complex nursing issues
• Referrals through ARC Acknowledgement to Mary Kearns TNP St. George GFS
Sutherland Flying
Squad • COAG and NPACT funding
• Geriatrician and Nurse Practitioner
• 8am-9pm, Monday to Friday
• Average response time 80 minutes
• Referrals only from the aged care facilities
• 25 facilities
Sutherland Flying
Squad • Acute deterioration requiring ED transfer
• Assessment and management in aged care facility
• IV antibiotics, IV/subcutaneous fluids, behavioral management, end of life care
• Direct hospital admission if deemed necessary
• NP also involved in outbreak management, catheter and SPC changes, PEG insertion
• Support from community nurses – IV medications, wound management and weekend cover
Acknowledgement to Dr. Shikha Jain Staff Specialist and Ange Patras NP Sutherland GFS
Outcomes-Patients
• Patient are provided holistic medical and nursing
care in their residence
• Patients able to remain in their residence for
medical management, resulting in:
– improved mental wellbeing of patients with
cognitive disorders
– patients remaining in their home for end of life
care
– increased patient, family, carer satisfaction
Outcomes for patients
• Decreased patient anxiety and
stress related to changing
environment, transportation and
hospitalisation
• Patient, carer and family
satisfaction
Outcomes health care
system • Reduced ED presentations
• Reduced Acute hospitalizations
• Reduced demand on ambulance services
• Efficiency savings
Impact on RACF
• Availability of specialist education and
resources
• Staff confidence in managing acutely
unwell patients
• Streamlining of staff workload
• Implementation of end of life care
pathways
• Staff satisfaction
Geriatric Flying
Squads $$$ Savings
War Memorial $166,825 in 12 months
St. George $300,000 in 7 months
Sutherland $430,000 in 12 months
Healthy at Home
• Set up as part of the Safte program – clinical redesign by DOH in 2005
• 4 sites – Newcastle, St. George, Queenbeyan and Hornsby
• Only Newcastle and St. George still exist
• Partnership of the area health services and community options for rapid response to community based elderly at risk of hospitalization
Healthy at Home
Newcastle • Part of the HNELHD Greater Newcastle Cluster
Community Acute Post Acute Care (CAPAC)
Service
• Healthy at Home, Hospital in the Home and
Transitional Aged Care all under one umbrella
• 7 day a week service
• Nurse co-ordinated
• Multidisciplinary team with a geriatrician
Healthy at Home
Newcastle • Referrals from anyone who comes in
contact with the client
• 48 hour response time
• Up to 6 week duration – refer on
• 30 - 40 referrals a month
• Community partnership – able to get
services in immediately
• Very similar to War Memorial Flying Squad
Healthy at Home
Newcastle
• Aged over 65 yrs (45yrs for ATSI)
• Complex clients
• Absence of recent medical interventions
• Challenging social situations
• Hoarding and squalor
• Falls/ decreased mobility, declining cognition, poly-pharmacy, continence issues
• Acknowledgment to Sandy Ryan and Jacqueline Greenham : LNELHD – Greater
Newcastle Cluster - CAPAC Service
David
• 83 yo gentleman, referred by ACAT
• Living in squalid boarding house
accommodation in Kings Cross
• Retired lawyer who had lost his fortune
• One niece in the blue mountains
David
• Issues
• Cognitive decline
• OA in his knees
• COPD
• High bath tub
• No services
• Squalid accommodation – was happy to move but wanted to live independently, and wanted to stay in the cross
David
• Multi-disciplinary involvement
• Nursing – case management
• Social Work –housing and services
• Geriatrician – diagnosis and management
• Physiotherapy
David
• Knee replacement
• Rehabilitation
• Eviction
• Rehoused in a low care facility in Redfern
• A happy ending
Future Plans for War
Memorial’s GFS
• 7 day a week service
• Expand into Residential aged care
facilities
• Research into benefits of community
program
Contact Details
Amanda Klahr – Clinical Nurse Consultant
Geriatric Flying Squad
War Memorial Hospital
125 Birrell St, Waverley 2024
Tel. 9369 0313 or 0457 559 253