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

Purpose:
Unclear referral pathways for elderly patients resulted in delays in and duplication of assessment.This increased length of stay and potential further decline of elderly patients.The GATE program streamlined referrals using a comprehensive,integrated geriatric assessment system for patients over 65.

Significance:
Poor process added to bedblock and delayed flow through the acute admission. Waiting times to access Residential and community services, or inpatient rehabilitation and geriatric services was excessive. Assessment processes for approval could take 4 weeks with waiting lists peaking at 40 patients.

Strategy and Implementation:
The GATE program is an aged care assessment and liaison program advocating for elderly patients admitted to acute care. It addresses timely review for patients referred to geriatric rehabilitation and Residential or Transitional care programs. This involved designating a single contact point for all geriatric referrals. Comprehensive assessment was completed using specific tools administered by trained assessors. Data was entered into software allowing Geriatrician advice and printed reports. The service also managed inpatient rehabilitation bed allocation. Implementation commenced on the internal medical units. Initially, all patients over the age of 70 with a stay of more than 48 hours were screened. Those returning a positive outcome received a full assessment by a gerontic nurse. This system later changed to a referral process. Online data was incorporated into scheduled face to face consultation reviews for all patients. This model was finalised and extended to other wards.

Evaluation:
More than 95% of patients referred were assessed within 2 working days, with decreases in duplication, waiting time for assessment, and inpatient length of stay. The waiting time for transfer to rehabilitation decreased from 7 days to 0 days with a 25% increase in the number of separations per year.

Implications for Practice:
Use of technology and evidence-based processes has significantly improved outcomes, with enhanced patient flow and exploration of Geriatric syndromes and rehabilitation potential. Geriatric rounds have improved the interface between acute and subacute and enable a “One stop shop” for all services.