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Pushing the envelope

Brisbane North PHN has recently rolled out two initiatives – Yellow Envelope and the Geriatric Outreach Assessment Service – to help or minimise the transition of aged care residents from facilities to hospitals.“The Yellow Envelope is a document in which residential aged care facilities can enclose a resident’s key healthcare information if they need togo to hospital,” said Brisbane North PHN executive via ambulance to emergency departments for conditions that could be treated in their place of residence, in their home, if there were sufficient support services to do that. GPs are very busy in their practices and it’s difficult for them to get out and visit people. They have appointment schedules and so it’s hard for them to provide that service. Also sometimes it requires some specialist expertise that is difficult manager, aged and community care, Michele Smith. “It supports safer clinical handover between the aged care facility and the hospital.

“The Geriatric Outreach Assessment Service provides specialist medical advice and support to GPs who care for aged care residents in Chermside and surrounding suburbs to avoid the need to send residents to the emergency department to access this treatment.”

Nursing Review spoke to Smith about these initiatives and related issues, such as patient data security and privacy.

NR: Can you give us an overview of the initiatives?

MS: Part of the Primary Health Network charter is to keep people well and at home and out of hospital. So we want to avoid people going to hospital if there’s a better care option, and we do a lot of work across the aged care and health sectors, both primary health and secondary. We talk to GPs in hospitals and residential aged care and community service providers, and try to get a feel for what the needs are in the local community. A lot of the feedback that we received through that consultation process last year was that many people in residential aged care are transferred for them to access.

Likewise for the residential aged care facilities, staffing-wise it can be difficult for them to care for people, and emergency departments are not the best place for older people to be waiting around on trolleys, becoming more confused in an unfamiliar, chaotic environment.

Hospitals likewise, there’s a lot of evidence that says that people should be in hospital for the smallest possible amount of time; it’s important to get people out fast. That’s particularly true for older people. It’s not good for people to be lying in bed longer than they need to. It puts them at risk of lots of complications.

Taking all of that into account, we worked with the people involved in consultation to come up with some strategies. One of those strategies was that we needed a better handover process between residential aged care staff, the Queensland Ambulance Service and emergency departments. So for people who do need to be transferred, we had to have a better way of sharing that information about the person across the system, and then likewise on discharge, for that to go back to the residential aged care facility with some interim medication management strategies, just to make that all work a lot better for the residents.

That’s where the Yellow Envelope came into play. Ultimately, My Health Record may provide the long-term solution, but in the meantime we have this system of a yellow envelope, so it stands out, where the care plan, the person’s usual functional status and medications, all that sort of clinical information, along with any advanced health directives, or enduring power of attorney type information, can all go in the envelope and then be handed over to staff at the hospital.

Likewise, the information goes back to the residential aged care staff about what changed while that person was in hospital. So, what happened? What medications may have been changed? What treatment is required? And so it’s useful for the staff, for the facilities, but also for the GPs when they come back out and see their patients. So that’s the Yellow Envelope.

We’re using it across all of the Metro North Regions from the river up to Caboolture, so at Caboolture, Redcliffe, Prince Charles and Royal Brisbane hospitals. We’ve just done a launch recently and we’ll be going out and doing lots of education and promotion across the hospitals and also residential aged care facilities to increase the uptake. So far the response has been great. The residential aged care staff say it’s going to make things much easier for them, and likewise for the staff in the emergency department, and also for the Queensland Ambulance Service, that it’s not so difficult for them to get the information that’s needed for them to hand over.

I know there’s a lot of concern regarding patient privacy and the security of documents that detail people’s health. What precautions have you taken to ensure this physical resource is secure?

Well, historically, whenever anyone has gone to hospital, they’ve needed some information with them – like their usual medications, for instance – so that the treating medical staff in the emergency department know what it is that they’re ordinarily on and can do a proper assessment. But the envelope keeps it all together in a visible way that is then taken from the secure file in the facility, through the Queensland Ambulance Service staff’s hands, to the emergency department where it once again joins the physical medical file, and then likewise on the way back. So it’s probably more secure than what was happening before, because it is like a central, easily recognisable place to hold that information.

Has there been a call to expand this initiative outside your area and go statewide or national?

Yes, there has. We’ve been working with Queensland Health and the Health Improvement Unit to look at the opportunity on a state level, certainly.

I understand you have several other initiatives?

As a result of that consultation work and workshops, we’ve established a jointly funded geriatrician-led outreach service from Prince Charles Hospital to the Prince Charles catchment area. That provides a geriatrician, a registrar and two clinical nurses, and they provide support for general practitioners who would like some advice on how to manage the patients they have in the facilities, and it’s also to provide advice for the residential aged care staff. They can go out and do physical outreach visits to implement care, do a full geriatric assessment, implement some interim care, conduct some staff training and support, and can, over a seven- day period, provide that kind of ongoing support.

The service commenced in June, and so far more than 20 people have avoided going to hospital. For the few people who have needed to go to hospital, they bypass the emergency department and go straight to the ward or the diagnostic services that they need, so they’re not waiting around emergency departments. It’s streamlining the care in that way.

Also, people are able to be discharged back home quickly. It reduces the amount of time they need to be in hospital for to receive care that can be provided with support back in their home, which is the residential aged care facility.

Would you like to add anything more?

The feedback so far is that the general practitioners who have referred to the service are really very happy with it and have found it to be a great support, because it does still keep them as the central coordinator of the person’s care and recognises their role in that.

Also, the staff in the facilities find the service extremely useful, and also the training that they get when the staff come out is good at building their capacity and to manage people in those facilities. The residents themselves have also reported a great deal of satisfaction with that service, so we’re very encouraged by that.

We’re hoping that we’re going to collect some really good data about the health outcomes improvement that might then inform investment into having a whole regionwide approach across the various hospitals, so that’s what we’re hoping the ultimate outcome might be.

Is there a website that people can go to if they’d like to learn more?

Yes, certainly. There’s some information on the Brisbane North PHN website (brisbanenorthphn.org.au) under Community Care. There’s a phone number and an email address where we canbe contacted.


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