Avoiding hospital admission of elderly patients using a home-based interdisciplinary allied health team; a pilot study

Kate Andersen1, Mr Patrick Brown1, Sue Fitzpatrick1

1Illawarra Shoalhaven Local Health District, Wollongong, Australia

Background / Objectives: Risk of hospital acquired adverse health outcomes in older patients has prompted efforts to avoid unnecessary hospital admission in this group (Pritchard et. Al 2020). Emergency Department attendances are often characterized by non-emergency presentation, such as consequences of a fall, breakdown in social care, or functional difficulties including a decrease in mobility (James 2011). The aim of this study was to pilot and evaluate the use of an Interdisciplinary Allied Health Quick Access Response Team (QuART) which provided a short intensive two-week allied health intervention to elderly patients (≥ 65 years) in their homes, with a focus on avoiding admission.

Methods: A prospective observational design was utilized to evaluate the impact of the QuART pilot. Teams comprising of six allied health disciplines provided a breadth of interdisciplinary skills, and commenced at two ISLHD sites in the second half of 2020.  Variables of interest relating to the QuART pilot included costings, utilization, referral sources, team activity, patient demographics, discharge outcomes and perceived impact on clinical/patient outcomes.

Results: A total of 206 patients were accepted into the program, across the two ISLHD sites over the period of the pilot, demonstrating that the program was well utilized. Of patients referred, 50% came from the Aged Services Emergency Team (ASET). Most QuART activity (60%) related to admission avoidance (patients referred to the program from ED). Most QuART patients (92%) were discharged safely with some requiring referral for follow-up allied health services. Average acute admission cost savings (NWAU for acute services 2019/20) relating to admission avoidance was $863,500 over the six month period of the pilot.  The patient experience of the program (Patient Reported Experience Measure, N=134) was overwhelmingly positive.

Conclusion: This program achieved a number of positive outcomes relating to admission avoidance, utilization, costings and positive patient experience.


Biography:

Kate Andersen (B.AppSc Occ Therapy), is the ISLHD Occupational Therapy Head of Discipline and Associate Director of Allied Health in the Shoalhaven. She has extensive experience, both as a clinician and in service development and has recently completed a Masters of Business Administration, in the area of Health Services Management. Kate has particular interest in reviewing clinical and diagnostic group data to support innovation and strengthen high value care.

Dr Sue Fitzpatrick is the Executive Director of Allied Health for the Illawarra Shoalhaven Local Health District. She is a certified practicing speech pathologist who completed a Doctor of Health Science in 2016 in the creation of an allied-health clinical supervision framework for evaluating and implementing clinical supervision for organizations, clinical leaders or individual health professionals. This Frameworks facilitates co-creation of collaborative clinical-supervision policy based on the needs of the participants, which is an important understanding for policy-makers. Dr Fitzpatrick has attained a broad healthcare experience through a wide range of senior leadership experiences and her current research focus extends to understanding the value of allied health across the healthcare environment.

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