Thesis abstract:

«p»Older people in residential aged care homes often live with complex health conditions, sometimes requiring hospital transfers and admissions. However, some of these hospital presentations are avoidable or unnecessary. The transfer from an aged care home to hospital can create a heightened sense of vulnerability to the resident transferred and can be a traumatic experience for them and their family. In many cases, quality clinical care can be provided for the resident while remaining in the aged care home. To reduce those avoidable hospital presentations, various types of outreach services, also known as hospital avoidance programs, have been in operation in many jurisdictions in Australia in the past 15 or more years. Numerous studies have shown the effectiveness of hospital avoidance programs for people living in aged care homes. These programs have a variety of clinician compositions. In Central Coast Local Health District (CCLHD), the nurse practitioner-led Aged Care Response Team (ACRT) provides support to aged care homes in avoiding unnecessary transfers of residents to emergency departments. In 2022-23, the model of care that ACRT provides was reviewed and recommended to incorporate the Aged Care Emergency (ACE) manual. The manual is a clinical support resource for the care of acutely unwell residents living in aged care homes. The ACE Manual contains clinical information and flow charts to guide Residential Aged Care Homes (RACHs) and ACE clinicians to determine the clinical needs of the acutely unwell resident. In this study we will use a mixed methods design to evaluate the ACRT hospital avoidance outreach intervention and investigate whether the model of care has led to improved patient outcomes (such as hospital avoidance; better patient experience). The research questions are:«/p» «p»· What is the impact of the nurse practitioner-led CCLHD ACRT in reducing the demand for hospital emergency department services.«/p» «p»· What are the barriers and enablers in the implementation of the ACRT from the perspectives of aged care home residents, their families, and clinicians?«/p» «p»· How do aged care policy, rules and regulations at local and national levels play a role in the fucntion of hospital avoidance services?«/p»