Aged Care Insite Issue 107 | Jun-Jul 2018 | Page 24

clinical focus REAPing the benefits Post-hospital care intervention reduces resident readmission. Nicholas Cordato interviewed by Dallas Bastian F ewer nursing home residents are needing to return to hospital after discharge under a program that involves regular specialist follow-up. The intervention, called Regular Early Assessment Post- Discharge (REAP), was developed by a team from Sydney’s St George Hospital, Calvary Health Care and UNSW’s Centre for Healthy Brain Ageing (CHeBA). REAP sees residents receive seven regular monthly conjoint geriatrician and nurse practitioner nursing home visits for the first six months following hospital admission. A study into the intervention’s effectiveness found REAP was associated with almost two-thirds fewer hospital readmissions, and half as many emergency department visits, compared with controls. Professor Henry Brodaty, study co-author and co-director of CHeBA, said that the total costs were also 50 per cent lower in the REAP intervention group. Lead author Dr Nicholas Cordato said re-hospitalisation of residents is costly, frequent, potentially avoidable and associated with poor survival and diminished quality of life. Aged Care Insite spoke with Cordato, a senior lecturer at UNSW and senior staff specialist at St George and Calvary hospitals, to find out what makes the program a success and whether it should be rolled out across Australia. 22 agedcareinsite.com.au ACI: The project is tackling the issue of re-hospitalisation and you said some cases are potentially avoidable, so setting aside the fact that many older Australians are frail coming into residential aged care, and with multiple comorbidities, why are we seeing people heading back to hospital after discharge? NC: Well, there are numerous factors that contribute to this problem. The fact that these people are frail means they are more susceptible to acute illness, and to adverse outcomes related to their illness. Their vulnerability is heightened by their frequent inability to articulate the symptoms, or their wishes, and this means that treatment can often be delayed, and medical issues aren’t prevented from evolving into something more serious. Conversely, hospital admissions often occur for conditions which really don’t respond to treatment very well, and the decision to send residents into hospital sometimes goes against the wishes of the resident and their family. The failure to appreciate these kinds of issues can lead to multiple re-presentations to hospital, and this can occur within a short space of time. So many of these treatments can often be given with equivalent effectiveness within nursing homes, and this can therefore potentially avoid transfer to hospital, and the hospital transfers can often be distressing and disorienting for residents. But implementation of these effective treatments in nursing homes, however, requires adequate levels of clinical input into nursing homes, and these treatments actually also need to be given in a timely manner. Most medical input into nursing homes is provided by GPs, but GPs are finding it increasingly challenging to provide this input regularly into nursing home residents’ care.