INVESTNET
PROJECT
Integrated Community Based Pathways supporting acute hospital admission alternatives in North Dublin.
TEAM:
Dr Liz Callaly, Clinical Co-Lead for Integrated Care for Older People HSE Dublin North Central (DNC);
Dr Róisín Purcell, Clinical Co-Lead for Integrated Care for Older People HSE DNC;
Dr Colm Byrne, Clinical Lead for MMUH Frailty at the Front Door;
Essene Cassidy, Head of Older Persons Services, HSE CHO DNCC;
Multidisciplinary teams – Community Specialist Team for Older People (CST-OP), Mater Frailty Intervention Team (Mater-FIT), Clontarf Hospital (Kincora ward), St Mary’s Hospital (Lambay ward), Post-Acute Care Unit, Fairview
LOCATION:
• Dublin North Central
• Mater Misericordiae Hospital
• Clontarf Hospital
• St Mary’s Hospital, Phoenix Park
• Post-Acute Care Unit, Fairview
THE PROBLEM:
With an ageing population, the acute care system assesses and treats an increasing number of older patients with frailty and complex health and care needs.
Frailty at the front door (FFD) services have been designed to support early Comprehensive Geriatric Assessments (CGA) and interventions including exploring alternatives to an acute hospital stay. This is challenging if alternatives are not available. For example, in most acute hospitals, access to specialist rehabilitation units is only available once the acute issue has been treated, yet older persons often need specialist rehabilitation while also addressing their presenting complaint.
THE SOLUTION:
In Dublin North Central and the Mater Hospital we developed an integrated collaborative service for older adults presenting to the Emergency Department (ED) and to other urgent outpatient services, reducing unnecessary acute hospital admissions and the hazards that accompany them, whilst also providing timely access to appropriate specialist care. The integrated pathways from ED and in the community consist of referral to home-based community specialist teams for older people (CST-OP), the use of beds in an off-site hospital-run post-acute care unit (PACU) and the use of daily-designated ‘FIT to Rehabilitation’ beds that provide same-day admission to affiliated rehabilitation units from the emergency department and from the community.
BENEFITS:
We collected data on 1,019 patient episodes that benefited from these pathways over a 2-year period. A total of 502 availed of them between July 2022 - June 2023 (258 CST-OP, 223 FIT to rehabilitation beds, 21 PACU) and this increased to 517 for July 2023 – June 2024 (266 CST-OP, 227 FIT to rehabilitation, 24 PACU). This is an estimated 9000 bed days saved per annum.
PROJECT CONTACT DETAILS: