A project involving Flinders Caring Futures Institute researchers Professor Gillian Harvey and Dr Elizabeth Lynch and led by Professor Maria Crotty from Flinders’ College of Medicine and Public Health has investigated strategies to improve older patients’ experiences with hospital admissions and discharge and reduce unnecessary re-presentations.
Lead Investigator Professor Harvey says increasing numbers of older people are seeking hospital care, with stays often short and readmission rates high. This places enormous pressure on the health system and can impact older people’s health.
“It’s a particularly bad outcome from the older person’s point of view, as deconditioning can occur in the hospital environment, which can subsequently result in another visit to hospital.”
Older people who are hospitalised are more prone to infection, cognitive decline and more likely to experience falls during their stay.
“It really increases their risk of complications, which is why we want to avoid unnecessary hospital stays,” Professor Harvey says.
A previous study identified a cohort of older patients who had between four and thirteen presentations to the Royal Adelaide Hospital in the space of twelve months. In partnership with Central Adelaide Local Health Network (CALHN) and COTA SA, a series of workshops engaged these people to share their experiences and discuss what they thought the problems were. Similar workshops were conducted with health and aged care providers to gauge their opinions and explore issues around gaps in care provision after discharge.
“That study fed into the State Action on Avoidable Rehospitalisations and Unplanned Admissions (STAAR-SA) project that aims to improve pathways of care for older South Australians following discharge from hospital,” Professor Harvey says.
As part of the STAAR-SA project, the research team examined data from the Registry of Senior Australians to identify the most at-risk groups of frequent presentation to hospital and the main risk factors. This led to the development of risk profiles for older people living in the community and residential aged care, to identify those who are most likely to re-present at hospital.
“We know that the greatest risk factor for a re-admission is a previous unplanned admission, for example,” Professor Harvey explains. “Future research could determine whether those risk profiles are accurate as a predictive tool and if they could be rolled out in the healthcare setting.”
The team also investigated existing services designed to reduce re-admissions in South Australia and heard more about the experience of older people receiving these services.
“One of the more poignant accounts was from a woman called Betty,” Professor Harvey says. “Betty was sent home from hospital late at night, in her night dress, when she was not ready to leave and had no one to care for her at home. This is just one example of current practices that can overlook the need to put patients at the centre of care.”
As part of the STAAR-SA project, a Quality Improvement Collaborative was established with nine multi-disciplinary teams working together to implement new, small-scale projects across the state to try and tackle some of these issues.
“Some groups were looking at medication reviews, while others were looking at access to virtual support in the home setting and the like,” Professor Harvey explains. “These teams were able to pilot new approaches to tackle specific problems.”
Rather than operate in isolation, like many organisations would often do, the multidisciplinary teams had the opportunity to work together to find solutions. Professor Harvey says it is a welcome outcome of the project.
One team that had received funding from The Hospital Research Foundation carried out a project titled There’s Something Missing in the Middle and trialled a care transition coordination service where healthcare workers looked after older people for up to six weeks post-discharge, ensuring they made their follow up GP appointments and organised any additional supports needed. Professor Harvey says the results from the six-month pilot study were promising.
“We’ve seen that this approach works. One of the positive outcomes of the STAAR-SA project is the development of a state-wide network, supported by Senior Translational Project Officer Carmel McNamara, made up of individuals committed to reducing unnecessary hospital readmissions and prepared to work together to improve people’s experiences.
“While there is no simple solution, if we bring organisations together in ways they haven’t worked together before we may be able to keep people out of hospital and ensure they receive the care they’re entitled to.”